Racial disparities in birth outcomes following assisted reproduction

Abstract

Racial disparities in adverse birth outcomes are well known. We examined the differences in the association between race/ethnicity and adverse birth outcomes between women who conceived spontaneously and those who used non-invasive assisted reproduction (nART), e.g., fertility drugs; and invasive assisted reproduction (iART), e.g., in-vitro-fertilization. A population-based retrospective cohort study, including data on all singleton (N=7,545,805) and twin (N=260,183) births in the USA, 2016-2017, from the National Centre for Health Statistics. Logistic regression was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI) and to assess statistical significance of the interaction between race/ethnicity and mode of conception (both self-reported). Twin births were analyzed separately. In women with singletons, assisted reproduction was used among 69778 (1.7%) non-Hispanic white women, 4669 (0.4%) African-American, 11124 (2.1%) Asian, and 7680 (0.4%) Hispanic women. AORs are shown in Tables 1&2. The largest increase in racial disparity was observed in neonatal mortality among women who used iART; African-American women had 4.4-fold higher risk compared with non-Hispanic white women (AOR=4.4, 95% CI 3.0-6.4), while this risk was 2-fold in the spontaneous conception group (AOR=1.9, 95% CI 1.8-2.0). In twins, assisted reproduction was used in 25,886 (17.4%) non-Hispanic white twins, 2004 (4.2%) African-American, 4198 (1.6%) Asian, and 3346 (24.8%) Hispanic twins. Twin results were similar, but slightly attenuated. Disparity in selected maternal morbidity was not different across the groups. Racial disparities in adverse perinatal outcomes among women who conceived spontaneously were aggravated in women who conceived by assisted conception. In particular, the disparity in neonatal mortality between African-American and non-Hispanic white women with ART was 2-fold larger than the disparity in those who conceived spontaneously. More research is needed to identify specific preventive measures after assisted conception among racial/ethnic minority women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)