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Title: Assisted Reproductive Technology and Perinatal Outcomes: Conventional versus discordant sibling design
Authors: Dhalwani, Nafeesa N.
Boulet, Sheree L.
Kissin, Dmitry M.
Zhang, Yujia
McKane, Patricia
Bailey, Marie A.
Hood, Maria-Elena (Malena)
Tata, Laila J.
First Published: 14-May-2016
Publisher: Elsevier on behalf of American Society for Reproductive Medicine
Citation: Fertility & Sterility, 2016, 106 (3), pp. 710–716.e2
Abstract: Objective: To compare risks of adverse perinatal outcomes between Assisted Reproductive Technology (ART) and naturally conceived singleton births using a dual design approach. Study design: Discordant sibling and conventional cross-sectional general population comparison. Setting: National ART Surveillance System from Michigan, Massachusetts and Florida (2000-2010) linked to birth records. Patients: all singleton live births, conceived naturally or via ART Interventions: None Main outcome measures: Birthweight, gestational age, low birthweight, preterm delivery, small-for-gestational age (SGA), low Apgar score. Results: 32,762(0.8%) of 3,896,242 singleton live births in the three states were conceived via ART. In 6,458 sibling pairs, ART conceived singletons were 33g lighter (Adjusted β=-33.40, 95% Confidence Interval (CI) -48.60,-18.21) and born half a day sooner (β=-0.58, 95% CI -1.02,-0.14) than singletons conceived naturally. The absolute risk of low birth weight and preterm birth was 6.8% and 9.7% respectively in the ART group and 4.9% and 7.9% in the non-ART group respectively. The odds of low birthweight were 33% higher (Adjusted Odds Ratio (aOR) =1.33, 95% CI 1.13, 1.56) and 20% higher for preterm birth (aOR=1.20, 95% CI 1.07, 1.34). The odds of SGA and low Apgar score were not significantly different in both the groups (aOR=1.22, 95% CI 0.88, 1.68 and aOR=0.75, 95% CI 0.54, 1.05 respectively). Results of conventional analyses were similar, although the magnitude of risk was higher for pre-term birth (aOR 1.51, 95% CI 1.46, 1.56). Conclusion: Despite some inflated risks in the general population comparison, ART remained associated with increased likelihood of low birthweight and preterm birth when underlying maternal factors were kept constant using discordant-sibling comparison.
DOI Link: 10.1016/j.fertnstert.2016.04.038
ISSN: 0015-0282
eISSN: 1556-5653
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © the authors, 2016. After an embargo period this version will be an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License ( ), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Description: The file associated with this record is embargoed until 12 months after the date of publication. The final published version may be available through the links above.
Appears in Collections:Published Articles, Dept. of Health Sciences

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