Impact of ART on pregnancies in California: an analysis of maternity outcomes and insights into the added burden of neonatal intensive care

Objective:we reviewed the occurrence of prematurity, low birth weight, multiple gestations, frequency of stillbirths and maternity care-associated variables including hospital stay and hospital charges of women conceiving using assisted reproductive technology (art) or artificial insemination (ai) compared with women with a history of infertility who conceived naturally, and all other naturally conceived pregnancies in california at non-federal hospitals between 2009 and 2011. at a single center, infants born after art/ai were compared with infants provided care in the normal nursery.study design:publically available inpatient data sets from the california office of statewide health planning and development for years 2009–2011 using data from all california non-federal hospitals were used to determine the impact of art on a variety of pregnancy-related outcomes and infant characteristics. infant data from a single center was used to determine hospital charges for infants delivered over an 18-month period to compare the hospital and physician charges indexed to similar charges for infants admitted to the ‘normal’ newborn nursery.result:among art/ai pregnancies, there was a 4–5-fold increase in stillbirths, compared with a 2–3-fold increase among women with infertility compared with other naturally conceiving women. art/ai pregnancies underwent more cesarean sections (fourfold), and a near fourfold increase in the rate of preterm deliveries. multiple gestations were increased 24–27-fold compared with naturally conceived pregnancies. maternal hospital stay and hospital charges were increased among those undergoing art/ai. infant charges were increased multi-fold for singletons, twins and triplets delivered after art/ai compared with naturally conceived infants.conclusion:multiple births, preterm births and a higher overall rate of fetal anomalies were found in california after art/ai for 2009–2011. cesarean section rates, longer length of maternal stay and hospital charges among women receiving art/ai could be lowered if emphasis on elective single embryo transfers was a higher priority among providers. charges for the care of infants delivered after art/ai are substantially higher than among naturally conceived infants born late preterm or at term. families seeking art/ai need to be informed of the impact of these adverse pregnancy outcomes, including neonatal outcomes and charges for medical care for their infant(s), when considering art/ai.