TABLE 4.
Risks of adverse pregnancy and birth outcomes by plurality at birth and assisted reproductive technology treatment parameters, 2004 through 2008, live births in Massachusetts
| Maternal outcomes |
Infant outcomes |
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|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Or other factor | Categories | Pregnancy hypertension |
Gestational diabetes |
Primary cesareanb |
Prematurity |
Low birthweight |
Small for gestational age |
Large for gestational age |
Birth defects |
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| OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | ||
| Plurality at birth | Single | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference |
|
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| Twina | 2.58d | 2.27–2.94d | 1.30d | 1.10–1.54d | 5.83d | 5.17–6.57d | 11.84d | 10.56–13.27d | 10.68d | 9.45–12.08d | 2.17d | 1.86–2.53d | 0.19d | 0.12–0.31d | 2.54d | 1.96–3.28d | |
|
| |||||||||||||||||
| Twinb | – | – | – | – | 4.29d | 3.36–5.48d | 7.51d | 5.84–9.65d | 6.42d | 4.86–8.48d | 1.58d | 1.14–2.19d | 0.21d | 0.14–0.33dd | 1.87d | 1.06–3.32d | |
|
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| Gestational | No | – | – | – | – | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference |
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| Diabetes | Yesc | – | – | – | – | 1.22d | 1.00–1.50d | 1.19 | 0.97–1.46 | 1.11 | 0.89–1.37 | 0.91 | 0.69–1.19 | 1.40d | 1.07–1.82d | 1.50d | 1.00–2.25d |
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| Pregnancy | No | – | – | – | – | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference |
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| Hypertension | Yesc | – | – | – | – | 1.86d | 1.58–2.18d | 2.70d | 2.32–3.15d | 1.83d | 1.56–2.14d | 1.16 | 0.94–1.43 | 1.17 | 0.92–1.48 | 1.06 | 0.74–1.52 |
|
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| Oocyte | Autologous | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference |
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| Source | Donor | 1.87d | 1.45–2.42d | 1.24 | 0.89–1.72 | 1.43d | 1.14–1.78d | 1.43d | 1.11–1.83d | 1.24 | 0.95–1.62 | 0.90 | 0.64–1.27 | 1.04 | 0.68–1.61 | 1.12 | 0.64–1.98 |
|
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| Semen | Autologous | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference |
|
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| Source | Donor | 1.28 | 0.85–1.95 | 0.85 | 0.47–1.52 | 1.12 | 0.80–1.59 | 0.77 | 0.51–1.17 | 0.63 | 0.39–1.01 | 0.64 | 0.34–1.19 | 1.12 | 0.66–1.91 | 0.75 | 0.27–2.06 |
|
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| ICSI | No | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference |
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| Yes | 0.91 | 0.78–1.06 | 1.07 | 0.89–1.29 | 1.04 | 0.92–1.17 | 0.92 | 0.80–1.05 | 0.95 | 0.82–1.10 | 1.20d | 1.00–1.43d | 1.14 | 0.92–1.41 | 0.78 | 0.57–1.06 | |
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| Assisted | No | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference |
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| Hatching | Yes | 0.92 | 0.80–1.07 | 0.96 | 0.80–1.15 | 1.01 | 0.90–1.13 | 1.01 | 0.88–1.15 | 0.95 | 0.83–1.10 | 1.01 | 0.85–1.21 | 0.91 | 0.74–1.12 | 0.93 | 0.69–1.26 |
|
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| Embryo | Fresh | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference |
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| State | Thawed | 1.30d | 1.08–1.57d | 0.99 | 0.78–1.25 | 1.06 | 0.91–1.23 | 1.12 | 0.94–1.33 | 0.79d | 0.65–0.96d | 0.38d | 0.28–0.53d | 1.10 | 0.43–2.84 | 0.94 | 0.63–1.40 |
|
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| Embryos | 1 | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference |
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| Transferred | 2 | 1.04 | 0.83–1.31 | 1.01 | 0.78–1.32 | 1.03 | 0.88–1.21 | 1.05 | 0.85–1.30 | 1.12 | 0.87–1.45 | 1.06 | 0.81–1.40 | 1.20 | 0.91–1.57 | 1.30 | 0.77–2.18 |
|
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| ≥3 | 1.11 | 0.86–1.43 | 1.01 | 0.75–1.35 | 1.13 | 0.94–1.35 | 1.15 | 0.91–1.45 | 1.21 | 0.92–1.60 | 1.08 | 0.80–1.46 | 1.17 | 0.86–1.60 | 1.32 | 0.75–2.31 | |
|
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| Fetal | 1 | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference | 1.00 | Reference |
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| Heartbeats | 2 | 0.94 | 0.69–1.27 | 1.33 | 0.97–1.82 | 1.01 | 0.82–1.24 | 1.49d | 1.16–1.91d | 1.57d | 1.19–2.08d | 1.32 | 0.96–1.82 | 0.78 | 0.54–1.12 | 1.42 | 0.81–2.51 |
|
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| ≥3 | 0.97 | 0.60–1.58 | 1.25 | 0.68–2.30 | 1.38 | 0.89–2.16 | 2.07d | 1.39–3.09d | 2.30d | 1.52–3.49d | 2.04d | 1.25–3.34d | 0.61 | 0.22–1.71 | 1.55 | 0.64–3.75 | |
Adapted.74
CI, confidence interval; ICSI, intracytoplasmic sperm injection; OR, odds ratio.
Models are adjusted for maternal and paternal age, race and ethnicity, and education; diagnoses; maternal preexisting medical conditions (chronic hypertension and other diabetes); plurality at 6 wk’ gestation and at birth; oocyte source; semen source; ICSI; assisted hatching; embryo state; and number of embryos transferred;
Models adjusted for all factors in model a, plus breech/malpresentation and cephalopelvic disproportion, and excluding women with prior cesarean delivery;
Models adjusted for all factors in model a, plus gestational diabetes and pregnancy hypertension;
Significant adjusted OR and 95% CIs.