Fineman DC, Keller RL, Maltepe E, Rinaudo PF, Steurer MA. Fertility treatment increases the risk of preterm birth independent of multiple gestations.
F S Rep 2023;
4:313-320. [PMID:
37719103 PMCID:
PMC10504569 DOI:
10.1016/j.xfre.2023.05.009]
[Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 09/19/2023] Open
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%; P<.001) and prematurity (no fertility treatment = 11.2%; NIFT = 23.4%; ART = 28.4%; P<.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.
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