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Preterm birth and low birth weight among in vitro fertilization singletons: A systematic review and meta-analyses

  • Sarah D. McDonald
    Correspondence
    Corresponding author at: McMaster University, Division of Maternal-Fetal Medicine, Departments of Obstetrics & Gynecology and Diagnostic Imaging and Clinical Epidemiology & Biostatistics, 1200 Main St. West, HSC 3N52B, Hamilton, Ontario L8N 3Z5, Canada. Tel.: +1 905 525 9140x26622; fax: +1 905 524 2911.
    Affiliations
    Division of Maternal-Fetal Medicine, Departments of Obstetrics & Gynecology, and Diagnostic Imaging, McMaster University, Hamilton, Canada
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  • Zhen Han
    Affiliations
    Department of Obstetrics and Gynecology, First Affiliated Hospital of Xi’an Jiao Tong University, Shaanxi Province, PR China
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  • Sohail Mulla
    Affiliations
    Faculty of Health Sciences, McMaster University, Hamilton, Canada
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  • Kellie E. Murphy
    Affiliations
    Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada

    Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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  • Joseph Beyene
    Affiliations
    Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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  • Arne Ohlsson
    Affiliations
    Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada

    Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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  • on behalf of the Knowledge Synthesis Group
    Author Footnotes
    1 See Appendix C.
  • Author Footnotes
    1 See Appendix C.

      Abstract

      Our objective was to determine the risks of preterm birth (PTB) and low birth weight (LBW) in singletons conceived through in vitro fertilization (IVF) ± intracytoplasmic sperm injection (ICSI) compared to spontaneously conceived singletons after matching or controlling for at least maternal age. The MOOSE guidelines for meta-analysis of observational studies were followed. Medline and Embase were searched using comprehensive search strategies. Bibliographies of identified articles were reviewed. English language studies examining LBW or PTB in singletons conceived by IVF or IVF/intracytoplasmic sperm injection, compared with spontaneously conceived singletons, that matched or controlled for at least maternal age. Two reviewers independently assessed titles, abstracts, full articles and study quality and extracted data. Dichotomous data were meta-analyzed using relative risks (RR) as measures of effect size with a random effects model and for continuous data weighted mean difference was calculated. Seventeen studies were included with 31,032 singletons conceived through IVF (±ICSI) and 81,119 spontaneously conceived singletons. After matching or controlling for maternal age and often other factors, compared to spontaneously conceived singletons, IVF singletons had increased risks of our two primary outcomes, PTB (RR 1.84, 95% CI 1.54, 2.21) and LBW (<2500 g, RR 1.60, 95% CI 1.29, 1.98). Singletons conceived through IVF or IVF/ICSI were at increased risk for late PTB (32–36 weeks, RR 1.52, 95% CI 1.01, 2.30), moderate PTB <32–33 weeks (RR 2.27, 95% CI 1.73, 2.97), very LBW (<1500 g, RR 2.65, 95% CI 1.83, 3.84), and intrauterine growth restriction (RR 1.45, 95% CI 1.04, 2.00), lower birth weights (−97 g, 95% CI −161 g, −33 g) and shorter mean gestations (−0.6 weeks, 95% CI −0.9 weeks, −0.4 weeks). In conclusion, IVF singletons have significantly increased risks of PTB, LBW and other adverse perinatal outcomes compared to spontaneously conceived singletons after matching or controlling for maternal age at least.

      Keywords

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