Births Trends in Assisted Reproductive Technology (ART) in the District of Columbia, 2009-2013

BACKGROUND:   Use of Assisted Reproductive Technology (ART) procedures to overcome the problem of infertility has increased steadily in the United States. Women who undergo ART procedures pose substantial risks to both mothers and infants, including pregnancy complications, multiple births, preterm delivery, and low birth weight. According to the Centers for Disease Control and Prevention (CDC), ART accounted for 1.4 percent of US births in 2009. However, the proportion of ART births in the District of Columbia is greater than 3 percent of all infants born in the same year. This study explored the trends of ART births among District of Columbia (DC) resident women on specific maternal conditions and demographic factors associated with risk of births in 2009-2013.

METHODS:   Electronic birth records were obtained from the DC Vital Statistics which yielded 46,087 live births to DC residents from 2009-2013. Of these births 1,069 (2.3 percent) resulted from ART. Logistic regression analysis was employed to see selected maternal conditions and demographic factors associated with the risk of ART births over the study period.

RESULTS:   More than 96 percent of ART births to DC resident mothers were among women aged 30 years and above, and among them about 30 percent were aged 40 years or older. White mothers were 4 times more likely to have ART births compared to non-white (OR:4.0, p<0.0001), while Hispanic mothers were less likely to have  ART births (OR:0.7, p<0.02) compared to non-Hispanic. Women with ART births had significantly higher risk for multiple births (OR: 13.1, p<0.0001), low birth weight infants (OR:1.5, p<0001), and C-section delivery (OR: 1.4, p<0.0001). However, prematurity was not a significant risk factor for DC women. The odds of delivering ART births among married women or those with no previous birth also increased significantly (OR: 4.9, p<0.0001 and OR: 2.4, p<0.0001, respectively).

CONCLUSIONS: Among ART births the annual incidence of low birth weight remained higher (20-32 percent), and while multiple birth rates declined significantly in recent years, it is well known that plurality results in health problems for both mom and baby. As more women in the District tend to delay pregnancy for various reasons, more research is warranted on the impact of assisted reproductive technology on maternal and child health outcomes.