title: Perinatal outcomes among singletons after assisted reproductive technology with single-embryo or double-embryo transfer versus no assisted reproductive technology.
abstract: OBJECTIVE
  To examine outcomes of singleton pregnancies conceived without assisted reproductive technology (non-ART) compared with singletons conceived with ART by elective single-embryo transfer (eSET), nonelective single-embryo transfer (non-eSET), and double-embryo transfer with the establishment of 1 (DET -1) or ≥2 (DET ≥2) early fetal heartbeats.
  
  
  METHODS
  Retrospective cohort using linked ART surveillance data and vital records from Florida, Massachusetts, Michigan, and Connecticut.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Singleton live-born infants.
  
  
  METHODS
  None.
  
  
  METHODS
  Preterm birth (PTB <37 weeks), very preterm birth (VPTB <32 weeks), small for gestational age birth weight (<10th percentile), low birth weight (LBW <2,500 g), very low birth weight (VLBW <1,500 g), 5-minute Apgar score <7, and neonatal intensive care unit (NICU) admission.
  
  
  RESULTS
  After controlling for maternal characteristics and employing a weighted propensity score approach, we found that singletons conceived after eSET were less likely to have a 5-minute Apgar <7 (adjusted odds ratio [aOR] 0.33; 95% CI, 0.15-0.69) compared with non-ART singletons. There were no differences among outcomes between non-ART and non-eSET infants. We found that PTB, VPTB, LBW, and VLBW were more likely among DET -1 and DET ≥2 compared with non-ART infants, with the odds being higher for DET ≥2 (PTB aOR 1.58; 95% CI, 1.09-2.29; VPTB aOR 2.46; 95% CI, 1.20-5.04; LBW aOR 2.17; 95% CI, 1.24-3.79; VLBW aOR 3.67; 95% CI, 1.38-9.77).
  
  
  CONCLUSIONS
  Compared with non-ART singletons, singletons born after eSET and non-eSET did not have increased risks whereas DET -1 and DET ≥2 singletons were more likely to have adverse perinatal outcomes.
authors.affiliation: Emory University Department of Gynecology and Obstetrics, Atlanta, Georgia; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: angela.matlack@gmail.com.
authors.forename: Angela S
authors.initials: AS
authors.lastname: Martin
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jeani
authors.initials: J
authors.lastname: Chang
authors.affiliation: Division of Reproductive Health, 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: Emory University Department of Gynecology and Obstetrics, Atlanta, Georgia; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Kawwass
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sheree L
authors.initials: SL
authors.lastname: Boulet
authors.affiliation: Maternal & Child Health Epidemiology Section, Lifecourse Epidemiology and Genomics Division, Michigan Department of Health & Human Services, Lansing, Michigan.
authors.forename: Patricia
authors.initials: P
authors.lastname: McKane
authors.affiliation: Massachusetts Department of Public Health, Boston, Massachusetts.
authors.forename: Dana
authors.initials: D
authors.lastname: Bernson
authors.affiliation: Emory University Department of Gynecology and Obstetrics, Atlanta, Georgia; Division of Reproductive Health, 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
authors.affiliation: Emory University Department of Gynecology and Obstetrics, Atlanta, Georgia; Division of Reproductive Health, 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
mesh_terms: D000328:Adult; D001034:Apgar Score; D001724:Birth Weight; D016009:Chi-Square Distribution; D016208:Databases, Factual; D004624:Embryo Transfer / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007246:Infertility / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007363:Intensive Care Units, Neonatal; D050498:Live Birth; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010343:Patient Admission; D011247:Pregnancy; D018873:Pregnancy Rate; D047928:Premature Birth / Q000209:etiology; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D056826:Single Embryo Transfer / Q000009:adverse effects; D016896:Treatment Outcome; D014481:United States
keywords: Assisted reproductive technology; double-embryo transfer; elective single-embryo transfer; in vitro fertilization; perinatal outcomes