Fertility Treatment Increases the Risk of Preterm Birth Independent of Multiple Gestations

Overview

Journal F S Rep

Specialty Reproductive Medicine

Date 2023 Sep 18

PMID 37719103

Authors

David C Fineman

Roberta L Keller

Emin Maltepe

Paolo F Rinaudo

Martina A Steurer

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate the complex interplay between fertility treatment, multiple gestations, and prematurity.

Design: Retrospective cohort study linking the national Center for Disease Control and Prevention infant birth and death data from 2014 to 2018.

Setting: National database from Center of Disease Control and Prevention.

Patients: In total, 19,454,155 live-born infants with gestational ages 22-44 weeks, 114,645 infants born using non IVF fertility treatment (NIFT), and 179,960 via assisted reproductive technology (ART).

Intervention: Noninvasive fertility treatment or ART vs. spontaneously conceived pregnancies.

Main Outcome Measures: The main outcome assessed was prematurity. Formal mediation analysis was conducted to calculate the percentage mediated by multiple gestations.

Results: Newborns born using NIFT or ART compared with those with no fertility treatment had a higher incidence of multiple gestation (no fertility treatment = 3.0%; NIFT = 24.7%; ART = 32.7%; <.001) and prematurity (no fertility treatment = 11.2%; NIFT = 23.4%; ART = 28.4%; <.001). Mediation analysis demonstrates that 76.8% (95% confidence interval [CI], 75.2%-78.1%) of the effect of NIFT on prematurity was mediated through multiple gestations. Similarly, 71.2% (95% CI, 70.8%-72.7%) of the effect of ART on prematurity is mediated through multiple gestation. However, the direct effect of NIFT on prematurity is 20.4% (95% CI, 19.0%-22.0%). The direct effect of ART was 24.7% (95% CI, 23.7%-25.6%).

Conclusion: A significant proportion of prematurity associated with fertility treatment is mediated by the treatment itself, independent of multiple gestations.

Citing Articles

National-level assessment of gestational carrier pregnancies in the United States.

Masjedi A, Mandelbaum R, Erickson K, Anderson Z, Matsuzaki S, Ouzounian J J Assist Reprod Genet. 2024; 42(1):201-211.

PMID: 39565425 PMC: 11805738. DOI: 10.1007/s10815-024-03320-5.

Risks of Placental Abruption and Preterm Delivery in Patients Undergoing Assisted Reproduction.

Zhang J, Lee R, Sauer M, Ananth C JAMA Netw Open. 2024; 7(7):e2420970.

PMID: 38985469 PMC: 11238021. DOI: 10.1001/jamanetworkopen.2024.20970.

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