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Pregnancy and Adoption Among Infertile Women Following Ovulation Induction and Intrauterine Insemination
AEP Vol. 19, No. 9 September 2009: 651–680
which influences risk for very preterm birth in black women. A proposed mechanism is physiologic changes triggered by chronic stress or ‘‘weathering’’ of maternal neuroendocrine systems. Racial and socioeconomic differences in the Ushaped curve describing national age-specific preterm birth risk support this general notion of premature aging in poor black women. We assessed whether degree of metropolitan residential segregation interacted with age to produce unique age-risk curves by geographic region. METHODS: Live singleton births to black women living in cities of 100,000 persons or greater in 2000–2004 were analyzed. Metropolitan segregation was measured with the isolation index in 231 cities. Bayesian hierarchical models with random intercepts for city and random slopes for age assess the cross-level interaction between area segregation and age, controlling for region, city size, and individual risk factors. RESULTS: Isolation segregation is associated with increased risk for very preterm birth (OR for 1 SD change in segregation 1.15, 95% CI 1.03, 1.28). Age is an independent predictor with lowest risk for mothers between ages 20– 24. There is modest evidence of interaction between segregation and age. For teens there is no effect of segregation but with increasing age, higher segregation increases risk for older mothers. CONCLUSION: Segregation is an independent risk factor for very preterm birth and may accelerate physiologic weathering resulting in geographic variation in risk for black women.
P78 PREPREGNANCY BMI, PREGNANCY WEIGHT GAIN, AND BIRTH OUTCOMES IN NORTHEAST CHINA NL Lee, A Correa, M Szklo, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
PURPOSE: To examine associations between prepregnancy weight and preterm birth (!37 weeks gestation), low birthweight (!2,500 g), and macrosomia (>4,000 g) in Beijing and Changchun. METHODS: We used data from a study of prenatal secondhand tobacco smoke exposure and birthweight among 3,000 post-partum women. Data were collected from medical records and interviews. Prepregnancy weight was categorized using body mass index (BMI) classifications for Asians. Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations of preterm birth, LBW, and macrosomia with prepregnancy BMI. RESULTS: Prevalence estimates of prepregnancy overweight and obese or very obese were 12.3% and 6.6%,
ABSTRACTS (ACE)
679
respectively. Prepregnancy obesity was associated with preterm birth (OR Z 2.1, 95% CI: 1.1, 4.2), and both overweight and obesity were significantly associated with macrosomia (OR Z 2.1 and 3.0, respectively). Prepregnancy BMI was not associated with LBW. High weight gain was significantly associated with a nearly two-fold increased risk for macrosomia and a reduced risk for preterm birth (OR Z 0.6, 95% CI: 0.3, 0.9), while low weight gain was significantly associated with a two-fold increased risk for preterm birth. Pregnancy weight gain was not significantly associated with LBW. CONCLUSION: These findings suggest that efforts to achieve a normal prepregnancy BMI and moderate gestational weight gain among overweight and obese women in northeast China could improve birth outcomes.
P79 PREGNANCY AND ADOPTION AMONG INFERTILE WOMEN FOLLOWING OVULATION INDUCTION AND INTRAUTERINE INSEMINATION C Ghosh, Department of Mathematics, State University of New York College at Buffalo, Buffalo, NY
PURPOSE: Assisted reproduction is a viable treatment option for many infertile couples with limited information to identify the population likely to get pregnant with or without treatment. Two hundred and fourteen women who underwent ovulation induction and IUI at a community clinic between 1991 and 1994 were followed up in 1998 to assess their overall health, pregnancy and adoption status since leaving the clinic. METHODS: Multivariate logistic regression analysis was used to estimate odds ratios adjusted for age, education, gravidity, parity, infertility subtype, number of IUI cycles, pregnancy during IUI treatment, and use of other assisted techniques such as IVF, ET or GIFT. RESULTS: Significant increased likelihood of pregnancy was observed for women less than 35 years of age versus older women (OR Z 2.10, 95% CI Z 1.18, 3.96), for women with secondary infertility versus primary infertility (OR Z 2.61, 95% CI Z 1.42, 4.80), and for women who used IVF, ET or GIFT versus those who did not (OR Z 1.98, 95% CI Z 1.01, 3.89). Significant decreased likelihood of adoption was observed for women with lower educational level versus a higher level (OR Z 0.19, 95% CI Z 0.05, 0.69), for women with secondary infertility versus primary infertility (OR Z 0.29, 95% CI Z 0.14, 0.70), and for parous versus nulliparous women (OR Z 0.12, 95% CIZ 0.02, 0.96). CONCLUSION: Our findings suggest that infertile women may conceive with or without ART without much change in overall health.
which influences risk for very preterm birth in black women. A proposed mechanism is physiologic changes triggered by chronic stress or ‘‘weathering’’ of maternal neuroendocrine systems. Racial and socioeconomic differences in the Ushaped curve describing national age-specific preterm birth risk support this general notion of premature aging in poor black women. We assessed whether degree of metropolitan residential segregation interacted with age to produce unique age-risk curves by geographic region. METHODS: Live singleton births to black women living in cities of 100,000 persons or greater in 2000–2004 were analyzed. Metropolitan segregation was measured with the isolation index in 231 cities. Bayesian hierarchical models with random intercepts for city and random slopes for age assess the cross-level interaction between area segregation and age, controlling for region, city size, and individual risk factors. RESULTS: Isolation segregation is associated with increased risk for very preterm birth (OR for 1 SD change in segregation 1.15, 95% CI 1.03, 1.28). Age is an independent predictor with lowest risk for mothers between ages 20– 24. There is modest evidence of interaction between segregation and age. For teens there is no effect of segregation but with increasing age, higher segregation increases risk for older mothers. CONCLUSION: Segregation is an independent risk factor for very preterm birth and may accelerate physiologic weathering resulting in geographic variation in risk for black women.
P78 PREPREGNANCY BMI, PREGNANCY WEIGHT GAIN, AND BIRTH OUTCOMES IN NORTHEAST CHINA NL Lee, A Correa, M Szklo, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
PURPOSE: To examine associations between prepregnancy weight and preterm birth (!37 weeks gestation), low birthweight (!2,500 g), and macrosomia (>4,000 g) in Beijing and Changchun. METHODS: We used data from a study of prenatal secondhand tobacco smoke exposure and birthweight among 3,000 post-partum women. Data were collected from medical records and interviews. Prepregnancy weight was categorized using body mass index (BMI) classifications for Asians. Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations of preterm birth, LBW, and macrosomia with prepregnancy BMI. RESULTS: Prevalence estimates of prepregnancy overweight and obese or very obese were 12.3% and 6.6%,
ABSTRACTS (ACE)
679
respectively. Prepregnancy obesity was associated with preterm birth (OR Z 2.1, 95% CI: 1.1, 4.2), and both overweight and obesity were significantly associated with macrosomia (OR Z 2.1 and 3.0, respectively). Prepregnancy BMI was not associated with LBW. High weight gain was significantly associated with a nearly two-fold increased risk for macrosomia and a reduced risk for preterm birth (OR Z 0.6, 95% CI: 0.3, 0.9), while low weight gain was significantly associated with a two-fold increased risk for preterm birth. Pregnancy weight gain was not significantly associated with LBW. CONCLUSION: These findings suggest that efforts to achieve a normal prepregnancy BMI and moderate gestational weight gain among overweight and obese women in northeast China could improve birth outcomes.
P79 PREGNANCY AND ADOPTION AMONG INFERTILE WOMEN FOLLOWING OVULATION INDUCTION AND INTRAUTERINE INSEMINATION C Ghosh, Department of Mathematics, State University of New York College at Buffalo, Buffalo, NY
PURPOSE: Assisted reproduction is a viable treatment option for many infertile couples with limited information to identify the population likely to get pregnant with or without treatment. Two hundred and fourteen women who underwent ovulation induction and IUI at a community clinic between 1991 and 1994 were followed up in 1998 to assess their overall health, pregnancy and adoption status since leaving the clinic. METHODS: Multivariate logistic regression analysis was used to estimate odds ratios adjusted for age, education, gravidity, parity, infertility subtype, number of IUI cycles, pregnancy during IUI treatment, and use of other assisted techniques such as IVF, ET or GIFT. RESULTS: Significant increased likelihood of pregnancy was observed for women less than 35 years of age versus older women (OR Z 2.10, 95% CI Z 1.18, 3.96), for women with secondary infertility versus primary infertility (OR Z 2.61, 95% CI Z 1.42, 4.80), and for women who used IVF, ET or GIFT versus those who did not (OR Z 1.98, 95% CI Z 1.01, 3.89). Significant decreased likelihood of adoption was observed for women with lower educational level versus a higher level (OR Z 0.19, 95% CI Z 0.05, 0.69), for women with secondary infertility versus primary infertility (OR Z 0.29, 95% CI Z 0.14, 0.70), and for parous versus nulliparous women (OR Z 0.12, 95% CIZ 0.02, 0.96). CONCLUSION: Our findings suggest that infertile women may conceive with or without ART without much change in overall health.