title: Risk factors associated with preterm birth among singletons following assisted reproductive technology in Australia 2007-2009--a population-based retrospective study.
abstract: BACKGROUND
  Preterm birth, a leading cause of neonatal death, is more common in multiple births and thus there has being an increasing call for reducing multiple births in ART. However, few studies have compared risk factors for preterm births amongst ART and non-ART singleton birth mothers.
  
  
  METHODS
  A population-based study of 393,450 mothers, including 12,105 (3.1%) ART mothers, with singleton gestations born between 2007 and 2009 in 5 of the 8 jurisdictions in Australia. Univariable and multivariable logistic regression models were conducted to evaluate socio-demographic, medical and pregnancy factors associated with preterm births in contrasting ART and non-ART mothers.
  
  
  RESULTS
  Ten percent of singleton births to ART mothers were preterm compared to 6.8% for non-ART mothers (P < 0.01). Compared with non-ART mothers, ART mothers were older (mean 34.0 vs 29.7 yr respectively), less socio-economically disadvantaged (12.4% in the lowest quintile vs 20.7%), less likely to be smokers (3.8% vs 19.4%), more likely to be first time mothers (primiparous 62.4% vs 40.5%), had more preexisting hypertension and complications during pregnancy. Irrespective of the mode of conception, preexisting medical and pregnancy complications of hypertension, diabetes and antepartum hemorrhages were consistently associated with preterm birth. In contrast, socio-demographic variables, namely young and old maternal age (<25 and >34), socioeconomic disadvantage (most disadvantaged quintile Odds Ratio (OR) 0.95, 95% Confidence Interval (CI): 0.77-1.17), smoking (OR 1.12, 95%CI: 0.79-1.61) and priminarity (OR 1.19, 95% CI: 1.05-1.35, AOR not significant) shown to be associated with elevated risk of preterm birth for non-ART mothers were not demonstrated for ART mothers, even after adjusting for potential confounders. Nonetheless, in multivariable analysis, the association between ART and the elevated risk for singleton preterm birth persisted after controlling for all included confounding medical, pregnancy and socio-economic factors (AOR 1.51, 95% CI: 1.42-1.61).
  
  
  CONCLUSIONS
  Preterm birth rate is approximately one-and-a-half-fold higher in ART mothers than non-ART mothers albeit for singleton births after controlling for confounding factors. However, ART mothers were less subject to the adverse influence from socio-demographic factors than non-ART mothers. This has implications for counselling prospective parents.
authors.affiliation: School of Medical Sciences, University of New South Wales, Kensington Campus, Sydney, NSW, 2052, Australia. 21388739@student.uwa.edu.au.
authors.forename: Xu K
authors.initials: XK
authors.lastname: Xu
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Randwick Hospitals Campus, Sydney, NSW, 2031, Australia. alex.wang@uts.edu.au.|Faculty of Health, University of Technology Sydney, City Campus, Sydney, NSW, 2007, Australia. alex.wang@uts.edu.au.
authors.forename: Yueping A
authors.initials: YA
authors.lastname: Wang
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Randwick Hospitals Campus, Sydney, NSW, 2031, Australia. zhuoyang.li@uts.edu.au.|Faculty of Health, University of Technology Sydney, City Campus, Sydney, NSW, 2007, Australia. zhuoyang.li@uts.edu.au.
authors.forename: Zhuoyang
authors.initials: Z
authors.lastname: Li
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Randwick Hospitals Campus, Sydney, NSW, 2031, Australia. Kei.Lui@SESIAHS.HEALTH.NSW.GOV.AU.|Department of Newborn Care, Royal Hospital for Women, Sydney, NSW, 2031, Australia. Kei.Lui@SESIAHS.HEALTH.NSW.GOV.AU.
authors.forename: Kei
authors.initials: K
authors.lastname: Lui
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Randwick Hospitals Campus, Sydney, NSW, 2031, Australia. elizabeth.sullivan@uts.edu.au.|Faculty of Health, University of Technology Sydney, City Campus, Sydney, NSW, 2007, Australia. elizabeth.sullivan@uts.edu.au.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D003920:Diabetes Mellitus; D005260:Female; D006470:Hemorrhage; D006801:Humans; D006973:Hypertension; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D008423:Maternal Age; D008875:Middle Aged; D009035:Mothers; D009099:Multiple Birth Offspring; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology*; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D064424:Tobacco Use; D055815:Young Adult