Objective: To assess associations between
assisted reproductive technology (ART) and adverse maternal and infant outcomes, with an emphasis on singletons. Methods: We linked data from the US ART
surveillance system with Massachusetts live birth-infant death records data for resident births in 1997-1998 and compared births conceived with ART (N = 3316) with births not conceived with ART or
infertility medications (N = 157,066) on: maternal chronic conditions,
pregnancy complications,
labor and delivery complications, and perinatal and infant outcomes. Results: Overall, ART was strongly associated with numerous
adverse outcomes. The magnitude was reduced for several outcomes when analyses were limited to singletons. After further exclusion of maternal subsets with rare ART births (
maternal age <20; education <high school; unmarried, no or
public health insurance; no or
third trimester prenatal care initiation), and matching ART and non-ART singletons on birth hospital, birth month and year,
maternal age, parity, and race/ethnicity, ART remained associated with pre-existing
diabetes (
Relative Risk [RR] = 2.2 95%
confidence interval 1.02-4.9), incompetent
cervix (RR = 6.0, [2.3-15.4]),
pregnancy-induced hypertension (RR = 1.5, [1.04-2.2]),
uterine bleeding (RR = 3.2, [1.5-6.8]),
placental abruption (RR = 3.8 [1.6-9.4]),
placenta previa (RR = 3.8, [1.6-9.4]),
preterm delivery (RR = 2.4, [1.8-3.0]), very
preterm delivery (RR = 2.5, [1.2-5.2]),
low birth weight (RR = 2.1, [1.5-2.9]), and infant not discharged home (RR = 1.8, [1.2-2.6]). Conclusions: Women who
conceive with ART are more likely than women who do not to enter
pregnancy with a chronic condition and develop complications during
pregnancy and
labor and delivery. Additionally, infants born after ART are at increased risk for adverse health outcomes. The mechanisms underlying these associations require further study.
