94 - Fertility status and treatments increase the risk of visits for respiratory conditions in the first year of life

Poster Number: 94
Publication Number: 94.438

Dmitry Dukhovny, Doernbecher Children's Hospital at Oregon Health & Science University, Lake Oswego, OR, United States; Sunah S. Hwang, University of Colorado School of Medicine, Aurora, CO, United States; Chia-ling Liu, MDPH, Boston, MA, United States; Daksha Gopal, Boston University School of Public Health, Boston, MA, United States; Leslie V. Farland, University of Arizona, Tucson, AZ, United States; Hafsatou Diop, Mass Department of Public Health, Boston, MA, United States; Howard J. Cabral, Boston University, Boston, MA, United States; Stacey A. Missmer, Michigan State University College of Human Medicine, Grand Rapids, MI, United States; Charles Coddington, Atrium Health, Charlotte, NC, United States; Xiaohui Cui, Massachusetts Department of Public Health, Boston, MA, United States; Judy E. Stern, Dartmouth-Hitchcock, West Rutland, VT, United States

Background: Fertility status and infertility treatments have adverse effects on newborn health during the birth hospitalization above that expected from increased prematurity alone. The degree to which fertility affects health later in childhood is unknown.  

Objective: To evaluate the effect of fertility status and treatments on healthcare encounters for respiratory conditions in offspring during the first year of life.

Design/Methods: We analyzed children born in Massachusetts (MA) from 1/1/13-12/31/16 by linking clinical assisted reproductive technology (ART) data from the Society for ART Clinic Outcome Reporting System (SART CORS) with the MA Pregnancy to Early Life Longitudinal (PELL) system (birth certificates linked to hospital discharge records), and the MA All Payer Claims Database (APCD). Analysis was limited to children who had one or more APCD claim during their first year of life and who never had MA Medicaid. We compared the relative risk (RR) of having one or more ICD-9 or 10 code for a respiratory disorder in infants born to those designated as: (1) fertile (without ART, other infertility treatments, or indicators of infertility), (2) infertile (defined by a woman having an ICD 9 or 10 code for infertility in APCD prior to delivery), or (3) ART-treated (linked to SART CORS). Results were stratified by preterm status ( < 34 weeks, 34-36 weeks, ≥ 37 weeks) and adjusted (aRR) for covariates that affected the risk. ARR was determined using general estimating equations with log link, Poisson distribution and an exchangeable correlation structure to account for multiple deliveries by the same woman.

Results: Of the 92,209 children in the study sample (74,095 fertile, 10,312 infertile, 7,802 ART), 63.2% had one or more respiratory claim in the first year of life. The risk of a child having any respiratory code was increased overall for both ART and infertile groups compared to fertile. In the stratified analyses, such increased risk was most notable in infants born ≥34 weeks but not observed in those born < 34 weeks in both ART and infertile compared to the fertile group (except ART vs. fertile in 34-36 week infants) (Table 1). There was no difference in ART compared to the infertile group (data not shown). The risk was increased in infertile and ART groups compared to fertile (but not in ART vs. infertile comparison) in all respiratory disease categories except for influenza/pneumonia and other conditions (Table 2). Conclusion(s): Fertility status and ART treatment increase the risk of child respiratory conditions in the first year of life. The mechanism for this population risk needs to be explored.
Table 1: Adjusted relative risk of respiratory visits in the first year of life by fertility groupaRR=adjusted relative risk; ICD-International Classification of Disease.
1. Relative risk approximated using general estimating equations with a log link, Poisson distribution and an exchangeable correlation structure to take into account multiple deliveries by the same women.
2. Multivariate models adjusted for maternal age, race/ethnicity, education, insurance at delivery, chronic diabetes mellitus, chronic hypertension, parity, plurality, mode of delivery, birth year, and gestational age (not in GA stratified analyses).
3. In addition to the variables adjustment for above, also adjusted for birth hospitalization ICD9/10 code.
There is no increased aRR when compairing the ART vs. infertile groups either in the overall or stratified analyses.
Table 2: Adjusted relative risk of specific respiratory visit categories in the first year of life by fertility group1. Relative risk approximated using general estimating equations with a log link, poisson distribution and an exchangeable correlation structure to take into account multiple deliveries by the same women.
2. Multivariate models adjusted for maternal age, race/ethnicity, education, insurance at delivery, chronic diabetes mellitus, chronic hypertension, parity, plurality, mode of delivery, birth year and gestational age.
aRR=adjusted relative risk; ICD-International Classification of Disease