Assisted Reproductive Technology and Early Intervention Program Enrollment

Abstract

We examined the prevalence of Early Intervention (EI) enrollment in Massachusetts comparing singleton children conceived via assisted reproductive technology (ART), children born to mothers with indicators of subfertility but no ART (Subfertile), and children born to mothers who had no indicators of subfertility and conceived naturally (Fertile). We assessed the natural direct effect (NDE), the natural indirect effect (NIE) through preterm birth, and the total effect of ART and subfertility on EI enrollment. METHODS:We examined maternal and infant characteristics among singleton ART (n = 6447), Subfertile (n = 5515), and Fertile (n = 306 343) groups and characteristics associated with EI enrollment includingpreterm birth using χ 2 statistics (α = 0.05). We estimated the NDE and NIE of the ART-EI enrollment relationship by fitting a model for enrollment, conditional on ART, preterm and the ART-preterm delivery interaction, and covariates. Similar analyses were conducted by using Subfertile as the exposure. RESULTS:The NDE indicated that the odds of EI enrollment were 27% higher among the ART group (odds ratio NDE = 1.27; 95% confidence interval (CI): 1.19 ̶ 1.36) and 20% higher among the Subfertilegroup (odds ratio NDE = 1.20; 95% CI: 1.12 ̶ 1.29) compared with the Fertile group, even if the rate of preterm birth is held constant. CONCLUSIONS:Singleton children conceived through ART and children of subfertile mothers both have elevated risks of EI enrollment. These findings have implications for clinical providers as they counsel women about child health outcomes associated with ART or subfertility.

Early Intervention Referral and Enrollment Among Infants with Neonatal Abstinence Syndrome

“…22 The percent of infants with NAS enrolled in EI programs was higher than estimates of children at risk of developmental delay among the general population 17 and near the range of infants in Massachusetts with clear diagnoses such as prematurity (range, 23.5%-44%). 14,15 Our cohort represents a clinically detected population of infants with NAS as evidenced by the high rate of medication treatment for NAS symptoms and hospitalization in the neonatal intensive care unit. Rates of referral and enrollment in EI would likely be lower for substance-exposed infants who are not diagnosed with NAS during their birth hospitalization.…”

“…Across the United States, only approximately 25% of all eligible children receive EI services. [13][14][15] Certain subpopulations, including African-American and Hispanic children and those with developmental delay, are even less likely to receive EI services compared with white infants and infants with established qualifying diagnoses or those born very preterm (<32 weeks). [16][17][18][19][20][21] This low rate of enrollment is likely related in part to individual factors such as parental health beliefs and psychosocial stressors, 22,23 as well as systemlevel factors involved in the EI referral and enrollment process.…”

Perinatal outcomes of singleton siblings: the effects of changing maternal fertility status

“…This analysis is part of a larger population-based study of ART in Massachusetts [14][15][16][17][18][19][20][21][22][23][24][25][26][27]. The objective of this current analysis is to evaluate the effect of maternal fertility status (fertile, subfertile, or ART) on the pregnancy and birth outcomes in consecutive singleton births.…”

Exposure to non-persistent chemicals in consumer products and fecundability: a systematic review

“…For example, there may be negative effects on couples' interpersonal, social and sexual life (Galhardo et al, 2011;Luk and Loke, 2015), economic consequences from the high costs of treatment and loss of earnings (Wu et al, 2013), and health risks associated with medical intervention (Mocanu et al, 2007). A number of studies have also shown that a history of impaired fecundity is associated with increased risk of adverse pregnancy outcomes (Messerlian et al, 2012;Wise et al, 2015;Seggers et al, 2016) and developmental problems in the child (Diop et al, 2016). Furthermore, research suggests that reduced fecundity may be a biomarker of poorer general health and shorter life expectancy and is linked to greater risks of reproductive and non-reproductive cancers (Eisenberg et al, 2016;Hanson et al, 2018), cardiovascular disease (Eisenberg et al, 2016;Latif et al, 2017) and earlier mortality in men and women (Jensen et al, 2009;Eisenberg et al, 2014).…”