Carmen Messerlian1, Robert W Platt2, Seang-Lin Tan3, Robert Gagnon3, Olga Basso4. 1. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. Electronic address: cmesser@hsph.harvard.edu. 2. Departments of Pediatrics and of Epidemiology and Biostatistics, McGill University Health Centre Research Institute, Montreal, Quebec, Canada. 3. Department of Obstetrics and Gynecology, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada. 4. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada.
Abstract
OBJECTIVE: To estimate the risk of preterm birth in singleton infants conceived through low-technology assisted reproduction (intrauterine insemination and/or ovulation induction/stimulation). DESIGN: Hospital-based cohort study. SETTING: University-affiliated hospital. PATIENT(S): Singleton babies born between 2001 and 2007 to 16,712 couples with no reported infertility (reference category), 378 babies conceived with low-technology treatment; 437 conceived with high-technology treatment; and 620 conceived naturally after a period of infertility. INTERVENTION(S): None. Treatment data were obtained from couples undergoing standard infertility investigation and care. MAIN OUTCOME MEASURE(S): Preterm birth, defined at three clinical endpoints: <37, <35, and <32 weeks of completed gestation. RESULT(S): After adjustment for age, parity, education, smoking, alcohol/drug use, and body mass index, the risk ratios and 95% confidence intervals (CI) of preterm birth for low technology were: 1.49 (CI: 1.12-2.00); 2.02 (CI: 1.30-3.13); and 2.93 (CI: 1.63-5.26) at <37, <35, and <32 weeks gestation, respectively, not dissimilar from the estimates for in vitro fertilization. Restricting the analysis to primiparas strengthened the association between treatment and preterm birth at the lower gestational endpoints. The increased risk persisted when the untreated group was used as the reference category, although the estimates were attenuated. CONCLUSION(S): In this large hospital-based cohort study, low-technology assisted reproduction appeared to be a moderately strong predictor of preterm birth, with similar associations observed in the high-technology treatment group. After adjusting for confounders, as well as the shared characteristics of infertile couples, associations were attenuated but remained significant, suggesting that part of the risk is likely attributable to the treatment.
OBJECTIVE: To estimate the risk of preterm birth in singleton infants conceived through low-technology assisted reproduction (intrauterine insemination and/or ovulation induction/stimulation). DESIGN: Hospital-based cohort study. SETTING: University-affiliated hospital. PATIENT(S): Singleton babies born between 2001 and 2007 to 16,712 couples with no reported infertility (reference category), 378 babies conceived with low-technology treatment; 437 conceived with high-technology treatment; and 620 conceived naturally after a period of infertility. INTERVENTION(S): None. Treatment data were obtained from couples undergoing standard infertility investigation and care. MAIN OUTCOME MEASURE(S): Preterm birth, defined at three clinical endpoints: <37, <35, and <32 weeks of completed gestation. RESULT(S): After adjustment for age, parity, education, smoking, alcohol/drug use, and body mass index, the risk ratios and 95% confidence intervals (CI) of preterm birth for low technology were: 1.49 (CI: 1.12-2.00); 2.02 (CI: 1.30-3.13); and 2.93 (CI: 1.63-5.26) at <37, <35, and <32 weeks gestation, respectively, not dissimilar from the estimates for in vitro fertilization. Restricting the analysis to primiparas strengthened the association between treatment and preterm birth at the lower gestational endpoints. The increased risk persisted when the untreated group was used as the reference category, although the estimates were attenuated. CONCLUSION(S): In this large hospital-based cohort study, low-technology assisted reproduction appeared to be a moderately strong predictor of preterm birth, with similar associations observed in the high-technology treatment group. After adjusting for confounders, as well as the shared characteristics of infertile couples, associations were attenuated but remained significant, suggesting that part of the risk is likely attributable to the treatment.
Authors: Carmen Messerlian; Joseph M Braun; Lidia Mínguez-Alarcón; Paige L Williams; Jennifer B Ford; Vicente Mustieles; Antonia M Calafat; Irene Souter; Thomas Toth; Russ Hauser Journal: Environ Int Date: 2017-06-27 Impact factor: 9.621
Authors: Natalie Dayan; K S Joseph; Deshayne B Fell; Carl A Laskin; Olga Basso; Alison L Park; Jin Luo; Jun Guan; Joel G Ray Journal: CMAJ Date: 2019-02-04 Impact factor: 8.262
Authors: Joseph B Stanford; Jessica N Sanders; Sara E Simonsen; Ahmad Hammoud; Mark Gibson; Ken R Smith Journal: Paediatr Perinat Epidemiol Date: 2016-03-23 Impact factor: 3.980
Authors: Jessica N Sanders; Sara E Simonsen; Christina A Porucznik; Ahmad O Hammoud; Ken R Smith; Joseph B Stanford Journal: Reprod Health Date: 2022-03-29 Impact factor: 3.355