Schieve, L. A., Meikle, S. F., Ferre, C., Peterson, H. B., Jeng, G., & Wilcox, L. S. (2002). Low and very low birth weight in infants conceived with use of assisted reproductive technology. The New England Journal of Medicine, 346(10), 731-737. https://doi.org/10.1056/NEJMoa010806
Schieve LA, Meikle SF, Ferre C, Peterson HB, Jeng G, Wilcox LS. Low and very low birth weight in infants conceived with use of assisted reproductive technology. N Engl J Med. 2002;346(10):731-737. doi:10.1056/NEJMoa010806
Schieve, Laura A., et al. "Low and very low birth weight in infants conceived with use of assisted reproductive technology." The New England Journal of Medicine, vol. 346, no. 10, 2002, pp. 731-737.
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RRM Academy Synopsis
Term singletons after ART had 2.6 times the low birth weight risk
Among 42,463 infants conceived with ART in the US in 1996 and 1997, term singletons had 2.6 times the low-birth-weight risk of the general population. ART twins had a low-birth-weight rate similar to all twins. In 1997, ART-conceived infants were 0.6 percent of births to mothers 20 and older but an estimated 4.3 percent of very-low-birth-weight infants.
Key Findings
Researchers analyzed 42,463 ART-conceived infants born in 1996 and 1997 and set them against expected counts built from 3,389,098 US births in 1997 to mothers aged 20 or older.
Among ART-conceived singletons born at 37 weeks or later, the low-birth-weight risk was 2.6 times that of the general population (2.4 to 2.7, 95 percent confidence interval).
Twins born at term after ART had a low-birth-weight ratio of 1.0 (1.0 to 1.1, 95 percent confidence interval) against all twins born at term.
Among 1997 births to mothers aged 20 or older, ART-conceived infants were 0.6 percent of infants, an estimated 4.3 percent of very-low-birth-weight infants, and an estimated 3.5 percent of low-birth-weight infants.
Among term singletons, the ratio was 1.9 (1.5 to 2.3, 95 percent confidence interval) with donor oocytes and no male-factor diagnosis, and 2.9 (2.5 to 3.3) with a male-factor diagnosis.
Interpretation
The retrospective study analyzed national registry data. Researchers compared the results with 1997 US birth certificates, adjusting for maternal age and parity (number of prior births). The comparison shows an association. The study had no comparison group of couples with infertility who conceived without ART. The authors suggest the risk at term may relate directly to the procedures and the preterm risk to conditions in the women. They advise caution with small subgroups. Data on pregnancy complications, delivery type, and ovulation drug use in the general population were not available.
RRM Context
The authors suggest the added risk of preterm low birth weight may come from conditions already present in the women. Restorative reproductive medicine looks for the cause of infertility in both partners and treats it. ART bypasses the reproductive system and does not answer why conception fails. Any such condition stays untreated.
Our editorial summary of this paper, not the article's abstract.
Abstract
Background
The increased risk of low birth weight associated with the use of assisted reproductive technology has been attributed largely to the higher rate of multiple gestations associated with such technology. It is uncertain, however, whether singleton infants conceived with the use of assisted reproductive technology may also have a higher risk of low birth weight than those who are conceived spontaneously.
Methods
We used population-based data to compare the rates of low birth weight (less-than-or-equal 2500 g) and very low birth weight (<1500 g) among infants conceived with assisted reproductive technology with the rates in the general population.
Results
We studied 42,463 infants who were born in 1996 and 1997 and conceived with assisted reproductive technology and used as a comparison group 3,389,098 infants born in the United States in 1997. Among singleton infants born at 37 weeks of gestation or later, those conceived with assisted reproductive technology had a risk of low birth weight that was 2.6 times that in the general population (95 percent confidence interval, 2.4 to 2.7). The use of assisted reproductive technology was associated with an increased rate of multiple gestations; however, its use was not associated with a further increase in the risk of low birth weight in multiple births. Among twins, the ratio of the rate of low birth weight after the use of assisted reproductive technology to the rate in the general population was 1.0 (95 percent confidence interval, 1.0 to 1.1). Infants conceived with assisted reproductive technology accounted for 0.6 percent of all infants born to mothers who were 20 years of age or older in 1997, but for 3.5 percent of low-birth-weight and 4.3 percent of very-low-birth-weight infants.
Conclusions
The use of assisted reproductive technology accounts for a disproportionate number of low-birth-weight and very-low-birth-weight infants in the United States, in part because of absolute increases in multiple gestations and in part because of higher rates of low birth weight among singleton infants conceived with this technology.
