Contributions to prematurity of maternal health conditions, subfertility, and assisted reproductive technology

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Authors:

Judy E. Stern, Ph.D., Chia-ling Liu, Sc.D., M.P.H., Sunah S. Hwang, M.D., M.P.H., Ph.D., Dmitry Dukhovny, M.D., M.P.H., Hafsatou Diop, M.D., M.P.H., Howard Cabral, Ph.D., M.P.H.

Abstract:

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.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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