A population-based study of maternal and perinatal outcomes associated with assisted reproductive technology in Massachusetts

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]), lowbirth 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.