Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada.
School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Pediatrics. 2022 Nov 1;150(5). doi: 10.1542/peds.2021-055855.
Although racial and ethnic disparities in adverse birth outcomes have been well documented, it is unknown whether such disparities diminish in women who use medically assisted reproduction (MAR). We examined differences in the association between maternal race and ethnicity and adverse birth outcomes among women who conceived spontaneously and those who used MAR, including assisted reproduction technology (ART), eg, in-vitro fertilization, and also non-ART MAR, eg, fertility drugs.
We conducted a population-based retrospective cohort study using data on all singleton births (N = 7 545 805) in the United States from 2016 to 2017. The outcomes included neonatal and fetal death, preterm birth, and serious neonatal morbidity, among others. Modified Poisson regression was used to estimate adjusted rate ratios (aRR) and 95% confidence intervals (CI) and to assess the interactions between race and ethnicity and mode of conception.
Overall, 93 469 (1.3%) singletons were conceived by MAR. Neonatal mortality was twofold higher among infants of non-Hispanic Black versus non-Hispanic White women in the spontaneous-conception group (aRR = 1.9, 95% CI: 1.8-1.9), whereas in the ART-conception group, neonatal mortality was more than fourfold higher in infants of non-Hispanic Black women (aRR = 4.1, 95% CI: 2.9-5.9). Racial and ethnic disparities between Hispanic versus non-Hispanic White women were also significantly larger among women who conceived using MAR with regard to preterm birth (<34 weeks) and perinatal mortality.
Compared to women who conceived spontaneously, racial and ethnic disparities in adverse perinatal outcomes were larger in women who used MAR. More research is needed to identify preventive measures for reducing risks among vulnerable women who use medically assisted reproduction.
尽管种族和民族差异导致不良妊娠结局的情况已有大量文献记载，但利用医学辅助生殖技术（MAR）的女性中，这种差异是否会减少尚不清楚。我们研究了自然妊娠和 MAR （包括辅助生殖技术[ART]，如体外受精，以及非-ART MAR，如生育药物）女性中，母亲种族和民族与不良妊娠结局之间的关联差异。
我们开展了一项基于人群的回顾性队列研究，使用了 2016 年至 2017 年美国所有单胎活产（N=7545805）的数据。结局包括新生儿和胎儿死亡、早产和严重新生儿并发症等。采用修正泊松回归来估计调整后的比率比（aRR）和 95%置信区间（CI），并评估种族和民族与受孕方式之间的交互作用。
总体而言，93469 （1.3%）例单胎活产是通过 MAR 受孕的。在自然受孕组中，非西班牙裔黑人婴儿的新生儿死亡率是西班牙裔或非西班牙裔白人婴儿的两倍（aRR=1.9，95%CI：1.8-1.9），而在 ART 受孕组中，非西班牙裔黑人婴儿的新生儿死亡率是西班牙裔或非西班牙裔白人婴儿的四倍多（aRR=4.1，95%CI：2.9-5.9）。在早产（<34 周）和围产儿死亡率方面，与西班牙裔或非西班牙裔白人女性相比，西班牙裔女性与非西班牙裔白人女性之间的种族和民族差异在利用 MAR 受孕的女性中也显著更大。
与自然受孕的女性相比，利用 MAR 的女性中，种族和民族差异导致的不良围产结局差异更大。需要开展更多研究，以确定针对利用医学辅助生殖的弱势女性的预防措施，以降低风险。
