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Contributions to prematurity of maternal health conditions, subfertility, and assisted reproductive technology.
Fertil Steril. 2020 Jul 02 [Online ahead of print]FS

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.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Dartmouth-Hitchcock, Lebanon, New Hampshire. Electronic address: judy.e.stern@dartmoth.edu.Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, Massachusetts.Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.Department of Pediatrics, Oregon Health and Science University, Portland, Oregon.Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, Massachusetts.Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32624216

Citation

Stern, Judy E., et al. "Contributions to Prematurity of Maternal Health Conditions, Subfertility, and Assisted Reproductive Technology." Fertility and Sterility, 2020.
Stern JE, Liu CL, Hwang SS, et al. Contributions to prematurity of maternal health conditions, subfertility, and assisted reproductive technology. Fertil Steril. 2020.
Stern, J. E., Liu, C. L., Hwang, S. S., Dukhovny, D., Diop, H., & Cabral, H. (2020). Contributions to prematurity of maternal health conditions, subfertility, and assisted reproductive technology. Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2020.03.036
Stern JE, et al. Contributions to Prematurity of Maternal Health Conditions, Subfertility, and Assisted Reproductive Technology. Fertil Steril. 2020 Jul 2; PubMed PMID: 32624216.
* Article titles in AMA citation format should be in sentence-case
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, Y1 - 2020/07/02/ PY - 2019/11/14/received PY - 2020/02/20/revised PY - 2020/03/26/accepted PY - 2020/7/7/entrez PY - 2020/7/7/pubmed PY - 2020/7/7/medline KW - ART KW - IVF KW - mediation analysis KW - placenta KW - prematurity KW - subfertility JF - Fertility and sterility JO - Fertil. Steril. 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. SN - 1556-5653 UR - https://www.unboundmedicine.com/medline/citation/32624216/Contributions_to_prematurity_of_maternal_health_conditions,_subfertility,_and_assisted_reproductive_technology L2 - https://linkinghub.elsevier.com/retrieve/pii/S0015-0282(20)30321-6 DB - PRIME DP - Unbound Medicine ER -
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