States Monitoring Assisted Reproductive Technology (SMART) Collaborative: Data Collection, Linkage, Dissemination, and Use

Abstract

Assisted reproductive technology (ART) refers to fertility treatments in which both eggs and sperm are handled outside the body. The Centers for Disease Control and Prevention (CDC) oversees the National ART Surveillance System (NASS), which collects data on all ART procedures performed in the United States. The NASS, while a comprehensive source of data on ART patient demographics and clinical procedures, includes limited information on outcomes related to women's and children's health. To examine ART-related health outcomes, CDC and three states (Massachusetts, Florida, and Michigan) established the States Monitoring ART (SMART) Collaborative to evaluate maternal and perinatal outcomes of ART and improve state-based ART surveillance. To date, NASS data have been linked with states' vital records, disease registries, and hospital discharge data with a linkage rate of 90.2%. The probabilistic linkage methodology used in the SMART Collaborative has been validated and found to be both accurate and efficient. A wide breadth of applied research within the Collaborative is planned or ongoing, including examinations of the impact of insurance mandates on ART use as well as the relationships between ART and birth defects and cancer, among others. The SMART Collaborative is working to improve state-based ART surveillance by developing state surveillance plans, establishing partnerships, and conducting data analyses. The SMART Collaborative has been instrumental in creating linked datasets and strengthening epidemiologic and research capacity for improving maternal and infant health programs and evaluating the public health impact of ART.

Perinatal outcomes of singleton siblings: the effects of changing maternal fertility status

“…ART national surveillance summaries are limited to birth outcomes reported by the patient herself or her obstetric provider [54][55][56]. Prior studies [44,45] have relied on linkages between ART cycles and vital records using only maternal and infant dates of birth or probabilistic algorithms [56].…”

“…ART national surveillance summaries are limited to birth outcomes reported by the patient herself or her obstetric provider [54][55][56]. Prior studies [44,45] have relied on linkages between ART cycles and vital records using only maternal and infant dates of birth or probabilistic algorithms [56]. Although there is a high degree of comparability between the SART CORS and vital records [27], our study design assures more accurate linkage between ART treatment cycles, vital records, and the hospital discharge birth data and a more complete picture of perinatal outcomes.…”

Assisted reproductive technology and the risk of preterm birth among primiparas

“…As previously described elsewhere (13), the SMART Collaborative was established to monitor and enhance ART surveillance within states and to study health outcomes among ART users. The SMART data set has been previously described.…”

Is the wrong question being asked in infertility research?

“…Developing means to collect subfertility information will be an important future direction for infertility research. Further, it is essential that we develop methods for longitudinal linkage of subfertility clinical data with population databases, such as is being spearheaded by CDC in several states in the USA [33][34][35][36]. As linkages between systems add breadth and a longitudinal dimension to outcome assessment, the potential for more sophisticated analyses that can separate the effects of ART from the underlying infertility-related diagnoses are possible but commitment from research funders and policymakers will be necessary to take advantage of the power of these research platforms.…”