title: Assisted Reproductive Technology and Early Intervention Program Enrollment.
abstract: OBJECTIVE
  We examined the prevalence of Early Intervention (EI) enrollment in Massachusetts comparing singleton children conceived via assisted reproductive technology (ART), children born to mothers with indicators of subfertility but no ART (Subfertile), and children born to mothers who had no indicators of subfertility and conceived naturally (Fertile). We assessed the natural direct effect (NDE), the natural indirect effect (NIE) through preterm birth, and the total effect of ART and subfertility on EI enrollment.
  
  
  METHODS
  We examined maternal and infant characteristics among singleton ART (n = 6447), Subfertile (n = 5515), and Fertile (n = 306,343) groups and characteristics associated with EI enrollment includingpreterm birth using χ(2) statistics (α = 0.05). We estimated the NDE and NIE of the ART-EI enrollment relationship by fitting a model for enrollment, conditional on ART, preterm and the ART-preterm delivery interaction, and covariates. Similar analyses were conducted by using Subfertile as the exposure.
  
  
  RESULTS
  The NDE indicated that the odds of EI enrollment were 27% higher among the ART group (odds ratioNDE = 1.27; 95% confidence interval (CI): 1.19 ̶ 1.36) and 20% higher among the Subfertilegroup (odds ratioNDE = 1.20; 95% CI: 1.12 ̶ 1.29) compared with the Fertile group, even if the rate of preterm birth is held constant.
  
  
  CONCLUSIONS
  Singleton children conceived through ART and children of subfertile mothers both have elevated risks of EI enrollment. These findings have implications for clinical providers as they counsel women about child health outcomes associated with ART or subfertility.
authors.affiliation: Massachusetts Department of Public Health, Boston, Massachusetts; hafsatou.diop@state.ma.us.
authors.forename: Hafsatou
authors.initials: H
authors.lastname: Diop
authors.affiliation: Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts;
authors.forename: Daksha
authors.initials: D
authors.lastname: Gopal
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts;
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
authors.affiliation: Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts;
authors.forename: Candice
authors.initials: C
authors.lastname: Belanoff
authors.affiliation: Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts;
authors.forename: Eugene R
authors.initials: ER
authors.lastname: Declercq
authors.affiliation: Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children and Harvard Medical School, Boston, Massachusetts;
authors.forename: Milton
authors.initials: M
authors.lastname: Kotelchuck
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan; and.
authors.forename: Barbara
authors.initials: B
authors.lastname: Luke
authors.affiliation: Department of Obstetrics and Gynecology and Pathology, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire.
authors.forename: Judy E
authors.initials: JE
authors.lastname: Stern
mesh_terms: D000328:Adult; D002657:Child Development; D002675:Child, Preschool; D002658:Developmental Disabilities; D018479:Early Intervention, Educational; D005260:Female; D005298:Fertility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology; D027724:Reproductive Techniques, Assisted; D012959:Socioeconomic Factors