title: A population-based study of maternal and perinatal outcomes associated with assisted reproductive technology in Massachusetts.
abstract: OBJECTIVE
  To assess associations between assisted reproductive technology (ART) and adverse maternal and infant outcomes, with an emphasis on singletons.
  
  
  METHODS
  We linked data from the US ART surveillance system with Massachusetts live birth-infant death records data for resident births in 1997-1998 and compared births conceived with ART (N = 3316) with births not conceived with ART or infertility medications (N = 157,066) on: maternal chronic conditions, pregnancy complications, labor and delivery complications, and perinatal and infant outcomes.
  
  
  RESULTS
  Overall, ART was strongly associated with numerous adverse outcomes. The magnitude was reduced for several outcomes when analyses were limited to singletons. After further exclusion of maternal subsets with rare ART births (maternal age <20; education <high school; unmarried, no or public health insurance; no or third trimester prenatal care initiation), and matching ART and non-ART singletons on birth hospital, birth month and year, maternal age, parity, and race/ethnicity, ART remained associated with pre-existing diabetes (Relative Risk [RR] = 2.2 95% confidence interval 1.02-4.9), incompetent cervix (RR = 6.0, [2.3-15.4]), pregnancy-induced hypertension (RR = 1.5, [1.04-2.2]), uterine bleeding (RR = 3.2, [1.5-6.8]), placental abruption (RR = 3.8 [1.6-9.4]), placenta previa (RR = 3.8, [1.6-9.4]), preterm delivery (RR = 2.4, [1.8-3.0]), very preterm delivery (RR = 2.5, [1.2-5.2]), low birth weight (RR = 2.1, [1.5-2.9]), and infant not discharged home (RR = 1.8, [1.2-2.6]).
  
  
  CONCLUSIONS
  Women who conceive with ART are more likely than women who do not to enter pregnancy with a chronic condition and develop complications during pregnancy and labor and delivery. Additionally, infants born after ART are at increased risk for adverse health outcomes. The mechanisms underlying these associations require further study.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. LSchieve@cdc.gov
authors.forename: Laura A
authors.initials: LA
authors.lastname: Schieve
authors.forename: Bruce
authors.initials: B
authors.lastname: Cohen
authors.forename: Angela
authors.initials: A
authors.lastname: Nannini
authors.forename: Cynthia
authors.initials: C
authors.lastname: Ferre
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Reynolds
authors.forename: Zi
authors.initials: Z
authors.lastname: Zhang
authors.forename: Gary
authors.initials: G
authors.lastname: Jeng
authors.forename: Maurizio
authors.initials: M
authors.lastname: Macaluso
authors.forename: Victoria C
authors.initials: VC
authors.lastname: Wright
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008404:Massachusetts / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011254:Pregnancy in Diabetics; D011272:Pregnancy, Multiple; D047928:Premature Birth; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*; D002581:Uterine Cervical Incompetence