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Neonatal-Perinatal Health Care Delivery: Epidemiology/Health Services Research

Neonatal-Perinatal Health Care Delivery 3: Epi/HSR Antenatal Exposures and Neonatal Outcomes

748 - The Effect of Fertility Treatment on Infant Mortality

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 748
Publication Number: 748.246

Meesha Sharma, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; David Fineman, Case Western Reserve University, Mill Valley, CA, United States; Martina Steurer, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Roberta Keller, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Emin Maltepe, UCSF, San Francisco, CA, United States

Presenting Author(s)

Meesha Sharma, MBBS, MPH

Pediatric Critical Care Fellow
University of California, San Francisco
San Francisco, California, United States

Background: Assisted reproductive technology (ART) and non-invasive fertility treatment (NIFT) are associated with adverse neonatal outcomes such as prematurity and low birth weight; multiple gestation has been identified as a major culprit. However, little is known about post-neonatal outcomes of infants conceived with these technologies.

Objective:

To determine the effect of ART/NIFT on neonatal and post-neonatal mortality by plurality status.

Design/Methods: Retrospective cohort study, using the CDC’s linked birth and infant death data for all births in the United States from 2014–2018. The main outcome was infant (<1y), neonatal (< 28d), and post-neonatal (28d-1y) mortality. The main predictor was fertility treatment; ART, NIFT and spontaneous conception. Unadjusted and adjusted odds ratios (OR) of mortality were calculated for each fertility group adjusting for maternal age, race, insurance, education, smoking, BMI, prenatal care, placental factors (pre- and gestational diabetes and hypertension) and gestational age. Results were stratified by plurality (single or multiple birth). Most common causes of death in each group were identified.

Results: 19,373,181 births were included. 192,384 (0.99%) were conceived by ART, and 119,203 (0.62%) by NIFT. ART and NIFT groups had statistically significant higher rates of infant and neonatal mortality, and lower rates of post-neonatal mortality compared to spontaneously conceived infants (Figure 1). This was true for both single and multiple births. After adjusting for confounders, odds of neonatal mortality remained statistically significantly higher in the ART and NIFT groups compared to spontaneously conceived infants. Odds of post-natal mortality remained lower for ART and NIFT groups, but the difference was no longer statistically significant (Table 1). Adjusting for gestational age reduced the effect sizes regardless of plurality but did not change statistical significance. The most common causes of neonatal death in all groups were low birth weight, prematurity and associated conditions. Sudden infant death syndrome and accidental injuries were more frequent among spontaneously conceived infants than in the ART/NIFT groups.

Conclusion(s): Fertility treatment is associated with higher neonatal mortality rates. However, compared to spontaneous conception, children conceived with ART and NIFT are less likely to die in the post-neonatal period. Interestingly, this difference is not statistically significant when adjusted for maternal factors. The potential etiologies for these post-neonatal differences, including socioeconomic status, warrant further investigation.