title: The Impact of ART on Live Birth Outcomes: Differing Experiences across Three States.
abstract: BACKGROUND
  Research has shown an association between assisted reproductive technology (ART) and adverse birth outcomes. We identified whether birth outcomes of ART-conceived pregnancies vary across states with different maternal characteristics, insurance coverage for ART services, and type of ART services provided.
  
  
  METHODS
  CDC's National ART Surveillance System data were linked to Massachusetts, Florida, and Michigan vital records from 2000 through 2006. Maternal characteristics in ART- and non-ART-conceived live births were compared between states using chi-square tests. We performed multivariable logistic regression analyses and calculated adjusted odds ratios (aOR) to assess associations between ART use and singleton preterm delivery (<32 weeks, <37 weeks), singleton small for gestational age (SGA) (<5th and <10th percentiles) and multiple birth.
  
  
  RESULTS
  ART use in Massachusetts was associated with significantly lower odds of twins as well as triplets and higher order births compared to Florida and Michigan (aOR 22.6 vs. 30.0 and 26.3, and aOR 37.6 vs. 92.8 and 99.2, respectively; Pinteraction < 0.001). ART use was associated with increased odds of SGA in Michigan only, and with preterm delivery (<32 and <37 weeks) in all states (aOR range: 1.60, 1.87).
  
  
  CONCLUSIONS
  ART use was associated with an increased risk of preterm delivery among singletons that showed little variability between states. The number of twins, triplets and higher order gestations per cycle was lower in Massachusetts, which may be due to the availability of insurance coverage for ART in Massachusetts.
authors.affiliation: College of Public Health, University of South Florida, Tampa, FL.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Luke
authors.affiliation: College of Public Health, University of South Florida, Tampa, FL.
authors.forename: William M
authors.initials: WM
authors.lastname: Sappenfield
authors.affiliation: College of Public Health, University of South Florida, Tampa, FL.
authors.forename: Russell S
authors.initials: RS
authors.lastname: Kirby
authors.affiliation: Michigan Department of Community Health, Lansing, MI.
authors.forename: Patricia
authors.initials: P
authors.lastname: McKane
authors.affiliation: Massachusetts Department of Public Health, Boston, MA.
authors.forename: Dana
authors.initials: D
authors.lastname: Bernson
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Yujia
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Farah
authors.initials: F
authors.lastname: Chuong
authors.affiliation: Massachusetts Department of Public Health, Boston, MA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Cohen
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Sheree L
authors.initials: SL
authors.lastname: Boulet
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Dmitry M
authors.initials: DM
authors.lastname: Kissin
mesh_terms: D000328:Adult; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D050498:Live Birth / Q000453:epidemiology*; D008404:Massachusetts / Q000453:epidemiology; D008824:Michigan / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data*; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data
keywords: Assisted Reproductive Technology; multiple birth; population-based; preterm birth; small-for-gestational age