TY - JOUR
T1 - Contributions to prematurity of maternal health conditions, subfertility, and assisted reproductive technology
AU - Stern, Judy E.
AU - Liu, Chia ling
AU - Hwang, Sunah S.
AU - Dukhovny, Dmitry
AU - Diop, Hafsatou
AU - Cabral, Howard
N1 - Funding Information:
Supported by grant no. RO1HD67270 from the National Institutes of Health , Bethesda, Maryland (to J.E.S.).
Publisher Copyright:
© 2020 American Society for Reproductive Medicine
PY - 2020/10
Y1 - 2020/10
N2 - Objective: To determine the maternal demographic, health, and fertility variables underlying prematurity. Design: Retrospective: Society for Assisted Reproductive Technology Clinic Outcome Reporting System data linked to Massachusetts birth certificates and hospital stays. Setting: Not applicable. Patients: We included 166,963 privately insured, singleton, first births to women ≥18 years of age between 2004 and 2013. Deliveries were as follows: assisted reproductive technology (ART) when linked to Society for Assisted Reproductive Technology Clinic Outcome Reporting System, medically assisted reproduction (MAR) when fertility treatment was indicated on the birth certificate, unassisted subfertile (USF) when there were indications of subfertility but no treatment, and fertile if none of the above. Intervention: None. Main Outcome Measures: Late preterm birth (LPTB; 34–36 weeks) and early preterm birth (EPTB; <34 weeks) were compared with term deliveries (≥37 weeks). Covariates that statistically significantly influenced prematurity in binary analysis were modeled by using multinomial logistic regression. Backward elimination and mediation analysis were used to determine the influence of single parameters on outcomes of others. Results: LPTB was increased in the USF (adjusted odds ratio [AOR] 1.32, 95% confidence interval [CI] 1.06–1.65) and ART (AOR 1.42, 95% CI 1.30–1.56) but not MAR (AOR 1.16, 95% CI 0.98–1.37). ETPB was increased in all (USF: AOR 1.67, 95% CI 1.21–2.31; MAR: AOR 1.67, 95% CI 1.31–2.12; ART: AOR 1.40, 95% CI 1.21–1.61). The strongest effectors of prematurity were placental problems (LPTB: AOR 4.02; EPTB: AOR 10.28), pregnancy hypertension (LPTB: AOR 2.14; EPTB: AOR 2.88), and chronic hypertension (LPTB: AOR 1.85; EPTB: AOR 2.79). Mediation analysis demonstrated a statistically significant indirect effect of placental problems for ART and subfertility. Conclusion: The greatest effectors of prematurity were placental problems and hypertensive disorders. ART and, to a lesser extent, subfertility were both associated with preterm birth directly and indirectly mediated by placenta problems.
AB - Objective: To determine the maternal demographic, health, and fertility variables underlying prematurity. Design: Retrospective: Society for Assisted Reproductive Technology Clinic Outcome Reporting System data linked to Massachusetts birth certificates and hospital stays. Setting: Not applicable. Patients: We included 166,963 privately insured, singleton, first births to women ≥18 years of age between 2004 and 2013. Deliveries were as follows: assisted reproductive technology (ART) when linked to Society for Assisted Reproductive Technology Clinic Outcome Reporting System, medically assisted reproduction (MAR) when fertility treatment was indicated on the birth certificate, unassisted subfertile (USF) when there were indications of subfertility but no treatment, and fertile if none of the above. Intervention: None. Main Outcome Measures: Late preterm birth (LPTB; 34–36 weeks) and early preterm birth (EPTB; <34 weeks) were compared with term deliveries (≥37 weeks). Covariates that statistically significantly influenced prematurity in binary analysis were modeled by using multinomial logistic regression. Backward elimination and mediation analysis were used to determine the influence of single parameters on outcomes of others. Results: LPTB was increased in the USF (adjusted odds ratio [AOR] 1.32, 95% confidence interval [CI] 1.06–1.65) and ART (AOR 1.42, 95% CI 1.30–1.56) but not MAR (AOR 1.16, 95% CI 0.98–1.37). ETPB was increased in all (USF: AOR 1.67, 95% CI 1.21–2.31; MAR: AOR 1.67, 95% CI 1.31–2.12; ART: AOR 1.40, 95% CI 1.21–1.61). The strongest effectors of prematurity were placental problems (LPTB: AOR 4.02; EPTB: AOR 10.28), pregnancy hypertension (LPTB: AOR 2.14; EPTB: AOR 2.88), and chronic hypertension (LPTB: AOR 1.85; EPTB: AOR 2.79). Mediation analysis demonstrated a statistically significant indirect effect of placental problems for ART and subfertility. Conclusion: The greatest effectors of prematurity were placental problems and hypertensive disorders. ART and, to a lesser extent, subfertility were both associated with preterm birth directly and indirectly mediated by placenta problems.
KW - ART
KW - IVF
KW - mediation analysis
KW - placenta
KW - prematurity
KW - subfertility
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U2 - 10.1016/j.fertnstert.2020.03.036
DO - 10.1016/j.fertnstert.2020.03.036
M3 - Article
C2 - 32624216
AN - SCOPUS:85087299577
SN - 0015-0282
VL - 114
SP - 828
EP - 836
JO - Fertility and sterility
JF - Fertility and sterility
IS - 4
ER -