Fertility treatment increases the risk of preterm birth independent of multiple gestations

Fineman, David C.; Keller, Roberta L.; Maltepe, Emin; Rinaudo, Paolo; Steurer, Martina A.

doi:10.1016/j.xfre.2023.05.009

Cited by 2 publications

(3 citation statements)

References 49 publications

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“…It is uncertain if the increased risks of preterm delivery associated with ART conception and placental abruption are due to ART itself or to complications resulting from ART. These technologies may directly influence placental abnormalities, epigenetic and genetic changes due to environmental manipulation, and underlying subfertility . One study found that manipulation of mouse embryos in vitro affected blastocyst gene expression, potential for implantation, and placental development .…”

Section: Discussionmentioning

confidence: 99%

“…These technologies may directly influence placental abnormalities, epigenetic and genetic changes due to environmental manipulation, and underlying subfertility. 52 One study found that manipulation of mouse embryos in vitro affected blastocyst gene expression, potential for implantation, and placental development. 41 On the other hand, ART pregnancies have been associated with an adverse maternal-fetal environment, 53 likely from compensatory mechanisms, which seem to have fewer implications for preterm delivery compared with fertility treatment or preterm delivery mediated by multiple gestations after ART.…”

Section: Discussionmentioning

confidence: 99%

“… 52 One study found that manipulation of mouse embryos in vitro affected blastocyst gene expression, potential for implantation, and placental development. 41 On the other hand, ART pregnancies have been associated with an adverse maternal-fetal environment, 53 likely from compensatory mechanisms, which seem to have fewer implications for preterm delivery compared with fertility treatment or preterm delivery mediated by multiple gestations after ART. As single FET cycles are increasingly used that less frequently produce multiple gestations, the roles of direct factors from ART and compensatory factors from an adverse maternal-fetal environment may play a larger role.…”

Section: Discussionmentioning

confidence: 99%

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

Zhang,

Lee,

Sauer

et al. 2024

JAMA Netw Open

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ImportancePatients using assisted reproductive technology (ART) may need additional counseling about the increased risks of placental abruption and preterm delivery. Further investigation into the potential additive risk of ART and placental abruption is needed.ObjectiveTo ascertain the risk of placental abruption in patients who conceived with ART and to evaluate if placental abruption and ART conception are associated with an increased risk of preterm delivery (&lt;37 weeks’ gestation) over and above the risks conferred by each factor alone.Design, Setting, and ParticipantsThis cross-sectional study used data from the National Inpatient Sample, which includes data from all-payer hospital inpatient discharges from 48 states across the US. Participants included women aged 15 to 54 years who delivered from 2000 through 2019. Data were analyzed from January 17 to April 18, 2024.ExposuresPregnancies conceived with ART.Main Outcomes and MeasuresRisks of placental abruption and preterm delivery in ART conception compared with spontaneous conceptions. Associations were expressed as odds ratios (ORs) and 95% CIs derived from weighted logistic regression models before and after adjusting for confounders. The relative excess risk due to interaction (RERI) of the risk of preterm delivery based on ART conception and placental abruption was also assessed.ResultsOf 78 901 058 deliveries, the mean (SD) maternal age was 27.9 (6.0) years, and 9 212 117 patients (11.7%) were Black individuals, 14 878 539 (18.9%) were Hispanic individuals, 34 899 594 (44.2%) were White individuals, and 19 910 807 (25.2%) were individuals of other races and ethnicities. Of the total hospital deliveries, 98.2% were singleton pregnancies, 68.8% were vaginal deliveries, and 52.1% were covered by private insurance. The risks of placental abruption among spontaneous and ART conceptions were 11 and 17 per 1000 hospital discharges, respectively. After adjusting for confounders, the adjusted OR (AOR) of placental abruption was 1.42 (95% CI, 1.34-1.51) in ART pregnancies compared with spontaneous conceptions, with increased odds in White women (AOR, 1.42; 95% CI, 1.31-1.53) compared with Black women (AOR, 1.16; 95% CI, 0.93-1.44). The odds of preterm delivery were significantly higher in pregnancies conceived by ART compared with spontaneous conceptions (AOR, 1.46; 95% CI, 1.42-1.51). The risk of preterm delivery increased when patients had both ART conception and placental abruption (RERI, 2.0; 95% CI, 0.5-3.5).Conclusions and RelevanceIn this cross-sectional study, patients who conceived using ART and developed placental abruption had a greater risk of preterm delivery compared with spontaneous conception without placental abruption. These findings have implications for counseling patients who seek infertility treatment and obstetrical management of ART pregnancies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Zhang,

Lee,

Sauer

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

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The effect of fertility treatment and socioeconomic status on neonatal and post-neonatal mortality in the United States

Sharma,

Fineman,

Keller

et al. 2024

J Perinatol

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Objective To determine the association between fertility treatment, socioeconomic status (SES), and neonatal and post-neonatal mortality. Study design Retrospective cohort study of all births (19,350,344) and infant deaths from 2014–2018 in the United States. The exposure was mode of conception—spontaneous vs fertility treatment. The outcome was neonatal (<28d), and post-neonatal (28d–1y) mortality. Multivariable logistic models were stratified by SES. Result The fertility treatment group had statistically significantly higher odds of neonatal mortality (high SES OR 1.59; CI [1.5, 1.68], low SES OR 2.11; CI [1.79, 2.48]) and lower odds of post-neonatal mortality (high SES OR 0.87, CI [0.76, 0.996], low SES OR 0.6, CI [0.38, 0.95]). SES significantly modified the effect of ART/NIFT on neonatal and post-neonatal mortality. Conclusions Fertility treatment is associated with higher neonatal and lower post-neonatal mortality and SES modifies this effect. Socioeconomic policies and support for vulnerable families may help reduce rates of infant mortality.

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Fertility treatment increases the risk of preterm birth independent of multiple gestations

Cited by 2 publications

References 49 publications

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

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

The effect of fertility treatment and socioeconomic status on neonatal and post-neonatal mortality in the United States

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