Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
JAMA Netw Open. 2022 Feb 1;5(2):e2147782. doi: 10.1001/jamanetworkopen.2021.47782.
Preterm birth is a global health issue. The association between fertility treatment and preterm singleton births has not been clarified.
To examine the association between fertility treatment and preterm birth.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used birth data that were submitted by 50 states and the District of Columbia to the National Vital Statistics System database. All mothers in the database who had a singleton live birth from January 1, 2016, to December 31, 2019, were included. Those who had preexisting hypertension or diabetes were excluded.
Fertility treatment categorized as assisted reproductive technology (ART) or non-ART treatment.
The main outcome was a diagnosis of preterm birth, which was defined as birth before 37 complete weeks (<259 days) of gestation. Gestational age was calculated by obstetric estimation at delivery and was collected from the database.
The final sample consisted of 14 370 920 mothers (mean [SD] age, 28.79 [5.79] years) with singleton live births. Of these women, 122 944 (0.9%) conceived by ART and 71 176 (0.5%) received non-ART treatment. The prevalence of preterm birth was 7.6% (n = 1 071 994) in natural conception, 10.7% (n = 13 205) in ART, and 9.3% (n = 6629) in non-ART groups. Compared with neonates who were naturally conceived, newborns who were conceived with ART (adjusted risk difference [aRD], 3.10% [95% CI, 2.93%-3.27%]; adjusted odds ratio [aOR], 1.49 [95% CI, 1.46-1.52]; P < .001) and non-ART treatment (aRD, 2.22% [95% CI, 2.00%-2.44%]; aOR, 1.35 [95% CI, 1.31-1.38]; P < .001) had significantly higher risk for preterm birth after full adjustment. These associations were similar in subgroups of participants as defined by baseline characteristics.
This study found that singleton neonates who were conceived by fertility treatment had higher rates of preterm birth. Further investigations are warranted into the association between ART or non-ART treatment and the risk of preterm birth in singleton neonates.
早产是一个全球性的健康问题。生育治疗与早产单胎的关系尚未明确。
研究生育治疗与早产之间的关系。
设计、地点和参与者：本基于人群的队列研究使用了由 50 个州和哥伦比亚特区向国家生命统计系统数据库提交的生育数据。数据库中所有在 2016 年 1 月 1 日至 2019 年 12 月 31 日期间有单胎活产的母亲均被纳入研究。那些患有预先存在的高血压或糖尿病的母亲被排除在外。
生育治疗分为辅助生殖技术（ART）或非 ART 治疗。
主要结局是早产的诊断，早产定义为妊娠不足 37 周（<259 天）。胎龄通过分娩时的产科估计值计算，并从数据库中收集。
最终的样本包括 14370920 名（平均[SD]年龄，28.79[5.79]岁）有单胎活产的母亲。其中，122944 名（0.9%）通过 ART 受孕，71176 名（0.5%）接受非 ART 治疗。自然受孕组的早产发生率为 7.6%（n=1071994），ART 组为 10.7%（n=13205），非 ART 组为 9.3%（n=6629）。与自然受孕的新生儿相比，接受 ART 受孕的新生儿（调整风险差异[aRD]，3.10%[95%CI，2.93%-3.27%]；调整后的优势比[aOR]，1.49[95%CI，1.46-1.52]；P<0.001）和非 ART 治疗（aRD，2.22%[95%CI，2.00%-2.44%]；aOR，1.35[95%CI，1.31-1.38]；P<0.001）在完全调整后早产的风险显著增加。这些关联在按基线特征定义的参与者亚组中相似。
本研究发现，接受生育治疗受孕的单胎新生儿早产率较高。进一步的研究需要调查 ART 或非 ART 治疗与单胎新生儿早产风险之间的关系。
