title: Fertility treatments and adverse perinatal outcomes in a population-based sampling of births in Florida, Maryland, and Utah: a cross-sectional study.
abstract: OBJECTIVE
  To investigate perinatal outcomes associated with fertility treatments, including assisted reproductive technology (ART), intrauterine insemination with ovulation stimulation (IUI), and ovulation stimulation alone (OS).
  
  
  METHODS
  Population-representative cross-sectional survey of women with live births, 2004-2008.
  
  
  METHODS
  Florida, Maryland, and Utah, USA.
  
  
  METHODS
  21 803 women, weighted to represent 1 022 597 women.
  
  
  METHODS
  Survey and birth certificate data were analysed with logistic regression models adjusted for age, education, race, income, and parity, using separate models for singletons and all births. We used two referent groups: (1) women who never used fertility treatment and (2) subfertile women conceiving without treatment.
  
  
  METHODS
  Preterm birth (<37 weeks), very preterm birth (<34 weeks), low birthweight (<2500 g), and very low birthweight (<1500 g).
  
  
  RESULTS
  Referent group 1: In singletons, ART was associated with preterm birth (OR 3.28; 95% CI 1.74, 6.20) and low birthweight (OR 2.91; 95% CI 1.99, 4.26). OS was also associated with low birthweight (OR 1.62; 95% CI 1.19, 2.19). Including all births, treatment was associated with preterm birth and low birthweight: ART (OR 6.21; 95% CI 4.21, 9.16 and OR 6.51; 95% CI 4.85, 8.73); IUI (OR 2.10; 95% CI 1.24, 3.56 and OR 2.41; 95% CI 1.54, 3.76); OS (OR 1.40; 95% CI 1.01, 1.94 and OR 2.10; 95% CI 1.60, 2.75), respectively. Referent group 2: ART was associated with both outcomes in all births, but not singletons.
  
  
  CONCLUSIONS
  Preterm birth and low birthweight associated with fertility treatments are largely attributable to multiple gestation, but are also related to underlying subfertility.
  
  
  CONCLUSIONS
  Preterm birth is associated with subfertility, and with fertility treatments through multiple gestation.
authors.affiliation: Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Stanford
authors.affiliation: Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Simonsen
authors.affiliation: Utah Department of Health, Maternal and Infant Health Program, Salt Lake City, UT, USA.
authors.forename: L
authors.initials: L
authors.lastname: Baksh
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005431:Florida; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007246:Infertility / Q000628:therapy; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008396:Maryland; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000209:etiology*; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*; D012307:Risk Factors; D014589:Utah
keywords: Infertility; intrauterine insemination; ovulation induction; pregnancy complications/epidemiology/etiology; pregnancy outcome premature birth/epidemiology/etiology; reproductive techniques-assisted