title: Embryo transfer practices and perinatal outcomes by insurance mandate status.
abstract: OBJECTIVE
  To use linked assisted reproductive technology (ART) surveillance and birth certificate data to compare ET practices and perinatal outcomes for a state with a comprehensive mandate requiring coverage of IVF services versus states without a mandate.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Live-birth deliveries ascertained from linked 2007-2009 National ART Surveillance System and birth certificate data for a state with an insurance mandate (Massachusetts) and two states without a mandate (Florida and Michigan).
  
  
  METHODS
  None.
  
  
  METHODS
  Number of embryos transferred, multiple births, low birth weight, preterm delivery.
  
  
  RESULTS
  Of the 230,038 deliveries in the mandate state and 1,026,804 deliveries in the nonmandate states, 6,651 (2.9%) and 8,417 (0.8%), respectively, were conceived by ART. Transfer of three or more embryos was more common in nonmandate states, although the effect was attenuated for women 35 years or older (33.6% vs. 39.7%; adjusted relative risk [RR], 1.46; 95% confidence interval [CI], 1.17-1.81) versus women younger than 35 (7.0% vs. 26.9%; adjusted RR, 4.18; 95% CI, 2.74-6.36). Lack of an insurance mandate was positively associated with triplet/higher order deliveries (1.0% vs. 2.3%; adjusted RR, 2.44; 95% CI, 1.81-3.28), preterm delivery (22.6% vs. 30.7%; adjusted RR, 1.31; 95% CI, 1.20-1.42), and low birth weight (22.3% vs. 29.5%; adjusted RR, 1.28; 95% CI, 1.17-1.40).
  
  
  CONCLUSIONS
  Compared with nonmandate states, the mandate state had higher overall rates of ART use. Among ART births, lack of an infertility insurance mandate was associated with increased risk for adverse perinatal outcomes.
authors.affiliation: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: sboulet@cdc.gov.
authors.forename: Sheree L
authors.initials: SL
authors.lastname: Boulet
authors.affiliation: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sara
authors.initials: S
authors.lastname: Crawford
authors.affiliation: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Yujia
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Saswati
authors.initials: S
authors.lastname: Sunderam
authors.affiliation: Massachusetts Department of Public Health, Boston, Massachusetts.
authors.forename: Bruce
authors.initials: B
authors.lastname: Cohen
authors.affiliation: Massachusetts Department of Public Health, Boston, Massachusetts.
authors.forename: Dana
authors.initials: D
authors.lastname: Bernson
authors.affiliation: Michigan Department of Community Health, Lansing, Michigan.
authors.forename: Patricia
authors.initials: P
authors.lastname: McKane
authors.affiliation: Florida Department of Health, Tallahassee, Florida.
authors.forename: Marie A
authors.initials: MA
authors.lastname: Bailey
authors.affiliation: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.affiliation: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Dmitry M
authors.initials: DM
authors.lastname: Kissin
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004624:Embryo Transfer / Q000191:economics / Q000379:methods* / Q000639:trends*; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000191:economics / Q000639:trends*; D008404:Massachusetts / Q000453:epidemiology; D008824:Michigan / Q000453:epidemiology; D009099:Multiple Birth Offspring; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D012189:Retrospective Studies
keywords: Assisted reproductive technology; embryo transfer; insurance coverage; multiple birth