OBJECTIVE To determine the maternal demographic, health, and fertility variables underlying prematurity. DESIGN Retrospective: Society for Assisted Reproductive Technology Clinic Outcome Reporting System data linked to Massachusetts birth certificates and hospital stays. SETTING Not applicable. PATIENTS We included 166,963 privately insured, singleton, first births to women ≥18 years of age between 2004 and 2013. Deliveries were as follows: assisted reproductive technology (ART) when linked to Society for Assisted Reproductive Technology Clinic Outcome Reporting System, medically assisted reproduction (MAR) when fertility treatment was indicated on the birth certificate, unassisted subfertile (USF) when there were indications of subfertility but no treatment, and fertile if none of the above. INTERVENTION None. MAIN OUTCOME MEASURES Late preterm birth (LPTB; 34-36 weeks) and early preterm birth (EPTB; <34 weeks) were compared with term deliveries (≥37 weeks). Covariates that statistically significantly influenced prematurity in binary analysis were modeled by using multinomial logistic regression. Backward elimination and mediation analysis were used to determine the influence of single parameters on outcomes of others. RESULTS LPTB was increased in the USF (adjusted odds ratio [AOR] 1.32, 95% confidence interval [CI] 1.06-1.65) and ART (AOR 1.42, 95% CI 1.30-1.56) but not MAR (AOR 1.16, 95% CI 0.98-1.37). ETPB was increased in all (USF: AOR 1.67, 95% CI 1.21-2.31; MAR: AOR 1.67, 95% CI 1.31-2.12; ART: AOR 1.40, 95% CI 1.21-1.61). The strongest effectors of prematurity were placental problems (LPTB: AOR 4.02; EPTB: AOR 10.28), pregnancy hypertension (LPTB: AOR 2.14; EPTB: AOR 2.88), and chronic hypertension (LPTB: AOR 1.85; EPTB: AOR 2.79). Mediation analysis demonstrated a statistically significant indirect effect of placental problems for ART and subfertility. CONCLUSION The greatest effectors of prematurity were placental problems and hypertensive disorders. ART and, to a lesser extent, subfertility were both associated with preterm birth directly and indirectly mediated by placenta problems.

中文翻译：

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对孕产妇健康状况、低生育力和辅助生殖技术早产的贡献

目的 确定导致早产的孕产妇人口统计学、健康和生育变量。设计回顾：辅助生殖技术协会临床结果报告系统数据与马萨诸塞州出生证明和住院时间相关联。设置 不适用。患者 我们纳入了 2004 年至 2013 年 18 岁以上女性的 166,963 名私人保险单胎第一胎。 (MAR) 当出生证明上指示生育治疗时，无辅助生育能力 (USF) 当有生育能力低下的迹象但没有治疗时，如果以上都没有，则可以生育。干预 无。主要结局指标将晚期早产（LPTB；34-36 周）和早期早产（EPTB；<34 周）与足月分娩（≥37 周）进行比较。通过使用多项逻辑回归对二元分析中对早产有统计学显着影响的协变量进行建模。使用反向消除和中介分析来确定单个参数对其他参数的影响。结果 LPTB 在 USF（调整优势比 [AOR] 1.32，95% 置信区间 [CI] 1.06-1.65）和 ART（AOR 1.42，95% CI 1.30-1.56）中增加，但在 MAR（AOR 1.16，95% CI）中没有增加0.98-1.37）。ETPB 全部增加（USF：AOR 1.67，95% CI 1.21-2.31；MAR：AOR 1.67，95% CI 1.31-2.12；ART：AOR 1.40，95% CI 1.21-1.61）。影响早产的最强因素是胎盘问题（LPTB：AOR 4.02；EPTB：AOR 10.28），妊娠高血压（LPTB：AOR 2.14；EPTB：AOR 2.88）和慢性高血压（LPTB：AOR 1.85；EPTB：AOR 2.79）。中介分析表明，胎盘问题对 ART 和生育力低下具有统计学上显着的间接影响。结论 早产的最大影响因素是胎盘问题和高血压疾病。ART 和（在较小程度上）不孕症都与胎盘问题直接和间接介导的早产有关。