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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Article info
Publication history
Published online: June 29, 2009
Accepted:
May 25,
2009
Received in revised form:
April 21,
2009
Received:
January 12,
2009
Identification
Copyright
© 2009 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
