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Disparities in prenatal health of infants conceived by assisted reproduction

Racial and ethnic disparities in adverse perinatal outcomes were significantly greater among women who used medically assisted reproduction (MAR) than those who conceived spontaneously, according to a study published in the journal Pediatrics.

“There is a gap in our knowledge about population-level racial disparities in birth outcomes among women who use assisted reproduction,” said principal investigator Sarka Lisonkova, MD, PhD, an associate professor of ob/gyn at the University of British Columbia (BC), Vancouver, BC, Canada.

The retrospective cohort study comprised data on all singleton births in the United States in 2016 and 2017 (n=7,545, 805). The authors used publicly available information from birth and death certificates and fetal death certificates obtained from the National Center for Health Statistics.

Overall, 1.3% of singletons were conceived by MAR.

Non-Hispanic Black, American Indian and Alaska Native (AIAN) and Hispanic mothers were on average younger and more likely to be obese, use Medicaid, unmarried and less educated than non-Hispanic White mothers.

AIAN mothers had the highest prevalence of smoking during pregnancy, obesity, and prepregnancy diabetes, whereas Asians and Pacific Islanders had the highest percentage of underweight mothers in all mode-of-conception groups.

The study’s primary outcome was neonatal death, defined as death within 28 days after birth.

In the spontaneous-conception group, neonatal mortality was twice as high among infants of non-Hispanic Black compared to non-Hispanic White women.

More starkly, among women who conceived by assisted reproductive technology (ART), including in-vitro-fertilization, neonatal mortality was roughly fourfold higher in infants of non-Hispanic Black women than in non-Hispanic White women.

Racial and ethnic disparities between Hispanic versus non-Hispanic White women were also significantly greater for preterm birth (<34 weeks) and perinatal mortality in women who conceived via MAR.

Non-Hispanic Black women who conceived using non-ART MAR (including, for instance, fertility drug treatments) were three times more likely to experience a fetal death than non-Hispanic White women.

“Socioeconomic status (SES) disparity has been implicated as one of the major drivers of racial/ethnic disparity in adverse birth outcomes,” Lisonkova told Contemporary OB/GYN®. “The premise was that racial/ethnic-related SES disparity among women who use MAR would be less than what we observe in pregnant women in the general population, because fertility treatments require financial resources. Surprisingly, though, the opposite was true: racial disparities were larger among women who conceived using assisted reproduction.”

The study offers information to healthcare providers about potential gaps in pregnancy and neonatal care for women with assisted reproduction and their infants, including all racial/ethnic groups.

To reduce the racial and ethnic disparities found in the study, “we need to further examine racial/ethnic differences in causes of infertility, types of fertility treatments and birth outcomes in women with multiple pregnancies, such as twins and triplets, which are more common following assisted reproduction than in natural conception,” said Lisonkova. “This will provide more information about possible improvements in clinical care.”

From a public health perspective, “we need to provide high-quality obstetric and neonatal care for women who conceive using fertility treatments, plus have care that is accessible, especially among minority racial/ethnic groups,” Lisonkova said. “We need to also ensure equal access to fertility therapies.”

Reference

Lisonkova S, Ukah UV, John S, et al. Racial and ethnic disparities in the perinatal health of infants conceived by ART. Pediatrics. Published online October 19, 2022. doi:org/10.1542/peds.2021-055855