title: Impact of ART on pregnancies in California: an analysis of maternity outcomes and insights into the added burden of neonatal intensive care.
abstract: OBJECTIVE
  We reviewed the occurrence of prematurity, low birth weight, multiple gestations, frequency of stillbirths and maternity care-associated variables including hospital stay and hospital charges of women conceiving using assisted reproductive technology (ART) or artificial insemination (AI) compared with women with a history of infertility who conceived naturally, and all other naturally conceived pregnancies in California at non-federal hospitals between 2009 and 2011. At a single center, infants born after ART/AI were compared with infants provided care in the normal nursery.
  
  
  METHODS
  Publically available inpatient data sets from the California Office of Statewide Health Planning and Development for years 2009-2011 using data from all California non-federal hospitals were used to determine the impact of ART on a variety of pregnancy-related outcomes and infant characteristics. Infant data from a single center was used to determine hospital charges for infants delivered over an 18-month period to compare the hospital and physician charges indexed to similar charges for infants admitted to the 'normal' newborn nursery.
  
  
  RESULTS
  Among ART/AI pregnancies, there was a 4-5-fold increase in stillbirths, compared with a 2-3-fold increase among women with infertility compared with other naturally conceiving women. ART/AI pregnancies underwent more cesarean sections (fourfold), and a near fourfold increase in the rate of preterm deliveries. Multiple gestations were increased 24-27-fold compared with naturally conceived pregnancies. Maternal hospital stay and hospital charges were increased among those undergoing ART/AI. Infant charges were increased multi-fold for singletons, twins and triplets delivered after ART/AI compared with naturally conceived infants.
  
  
  CONCLUSIONS
  Multiple births, preterm births and a higher overall rate of fetal anomalies were found in California after ART/AI for 2009-2011. Cesarean section rates, longer length of maternal stay and hospital charges among women receiving ART/AI could be lowered if emphasis on elective single embryo transfers was a higher priority among providers. Charges for the care of infants delivered after ART/AI are substantially higher than among naturally conceived infants born late preterm or at term. Families seeking ART/AI need to be informed of the impact of these adverse pregnancy outcomes, including neonatal outcomes and charges for medical care for their infant(s), when considering ART/AI.
authors.affiliation: The Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Merritt
authors.affiliation: The Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Goldstein
authors.affiliation: The Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Philips
authors.affiliation: The Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Peverini
authors.affiliation: The Department of Pediatrics, Loma Linda, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Iwakoshi
authors.affiliation: The Department of Obstetrics and Gynecology, and the Perinatal Education Program of Loma Linda University Children's Hospital, Loma Linda, CA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Rodriguez
authors.affiliation: The Department of Obstetrics and Gynecology, and the Perinatal Education Program of Loma Linda University Children's Hospital, Loma Linda, CA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Oshiro
mesh_terms: D002140:California / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data; D000013:Congenital Abnormalities / Q000453:epidemiology; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007234:Infant, Premature; D007315:Insemination, Artificial / Q000191:economics; D015931:Intensive Care, Neonatal / Q000191:economics; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data; D027724:Reproductive Techniques, Assisted / Q000191:economics / Q000706:statistics & numerical data*; D050497:Stillbirth / Q000453:epidemiology