title: Assisted reproductive technology and the risk of preterm birth among primiparas.
abstract: OBJECTIVE
  To investigate the risk of preterm birth among liveborn singletons to primiparas who conceived with assisted reproductive technology (ART) using four mutually exclusive categories of infertility (female infertility only, male infertility only, female and male infertility, and unexplained infertility) and to examine preterm birth risk along the gestational age continuum.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Singletons born to primiparas who conceived with or without ART.
  
  
  METHODS
  None.
  
  
  METHODS
  Preterm (<37 weeks' gestation) and preterm/early term birth <39 weeks' gestation).
  
  
  RESULTS
  For the male infertility only, female infertility only, combined male and female infertility, and unexplained infertility groups, ART-conceived singletons were significantly more likely than non-ART singletons to be born preterm: adjusted odds ratio (aOR) 1.24 (95% CI, 1.13, 1.37), aOR 1.60 (95% CI, 1.50, 1.70), aOR 1.49 (95% CI, 1.35, 1.64), and aOR 1.26 (1.12, 1.43) respectively. Among infants whose mothers were diagnosed with infertility, the odds of preterm birth were highest between 28-30 weeks [female infertility only, aOR 1.95 (95% CI, 1.59, 2.39); male and female infertility: 2.21 (95% CI, 1.62, 3.00)] compared with infants in the general population. Within the ART population, singletons of couples with female infertility only were more likely to be born preterm than singletons born to couples with other infertility diagnoses.
  
  
  CONCLUSIONS
  Among singleton births to primiparas, those conceived with ART had an increased risk for preterm birth, even when only the male partner had been diagnosed with infertility. The risk of preterm birth for ART-conceived infants whose mothers were diagnosed with infertility included the earliest deliveries.
authors.affiliation: Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan. Electronic address: galit@msu.edu.
authors.forename: Galit Levi
authors.initials: GL
authors.lastname: Dunietz
authors.affiliation: Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan.
authors.forename: Claudia
authors.initials: C
authors.lastname: Holzman
authors.affiliation: Michigan Department of Community Health, Maternal and Child Health Section, Lansing, Michigan.
authors.forename: Patricia
authors.initials: P
authors.lastname: McKane
authors.affiliation: Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan.
authors.forename: Chenxi
authors.initials: C
authors.lastname: Li
authors.affiliation: Division of Reproductive Health at Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sheree L
authors.initials: SL
authors.lastname: Boulet
authors.affiliation: Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan.
authors.forename: David
authors.initials: D
authors.lastname: Todem
authors.affiliation: Division of Reproductive Health at Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Dmitry M
authors.initials: DM
authors.lastname: Kissin
authors.affiliation: Michigan Department of Community Health, Lansing, Michigan.
authors.forename: Glenn
authors.initials: G
authors.lastname: Copeland
authors.affiliation: Massachusetts Department of Public Health, Boston, Massachusetts.
authors.forename: Dana
authors.initials: D
authors.lastname: Bernson
authors.affiliation: Department of Community and Family Health, University of South Florida, Tampa, Florida.
authors.forename: William M
authors.initials: WM
authors.lastname: Sappenfield
authors.affiliation: Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Diamond
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007246:Infertility / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D010298:Parity / Q000502:physiology*; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology*; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D055815:Young Adult
keywords: Assisted reproductive technology (ART); infertility; preterm birth