All ETDs from UAB

Advisory Committee Chair

Andrzej Kulczycki

Advisory Committee Members

Gordon W Bates

Alfred Bartolucci

Martha S Wingate

Beverly A Mulvihill

Document Type

Dissertation

Date of Award

2010

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

Most studies evaluating outcomes among infertility treatment users use a spontaneously conceived (SC) group for comparative purposes, despite obvious limitations to this approach. Further, lack of comprehensive U.S. data-sources recording infertility treatments, especially non-assisted reproductive technology (non-ART) infertility treatments, has hampered the ability of U.S. researchers to explore the effects of a particular infertility treatment modality (for example ART) on maternal and infant outcomes while controlling for the effects of infertility itself. The present study makes use of the new data item: "Pregnancy resulted from infertility treatment," further categorized into ART and non-ART infertility treatments--from the 2003 revision of birth certificate (BC). Texas live birth files for 2005-2006 were examined to determine maternal characteristics, maternal co-morbidities and complications of pregnancy, and adverse infant outcomes among live births from ART, and to compare these to non-ART live births. There were 3,491 non-ART and 767 ART live births in the study population. When compared to the non-ART infertility treatment group, mothers that used ART were older, white and higher educated, self-paying for the delivery, and less likely to use WIC food and to smoke during pregnancy. Using multiple logistic regression to control for several confounders, ART treatment remained an independent predictor for higher odds of non-vertex presentation, and poor 5 minute Apgar score while decreasing the odds for neonatal intensive care unit (NICU) admission. The results of this study suggest under-reporting of ART compared to the number of ART live births reported by CDC in its annual publication on ART success rates and non-ART compared to previous national estimates in the birth certficate data from the state of Texas for years 2005-2006. Improved education of providers and vital records collectors regarding these new data items and their importance is needed. Targeting secondary and tertiary prevention efforts on the individuals seeking infertility treatments is also recommended (both ARTs and non-ARTs) due to high prevalence of advanced maternal age (age>35 years), chronic illnesses and co-morbidities as well as the higher risk of multiple births in this group, which may lead to poorer pregnancy outcomes.

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