Embryo transfer practices and perinatal outcomes by insurance mandate status.
Embryo transfer practices and perinatal outcomes by insurance mandate status.
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DOI：
10.1016/j.fertnstert.2015.05.015
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发表时间：
2015-08
影响因子：
6.7
通讯作者：
States Monitoring ART Collaborative
中科院分区：
文献类型：
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作者：
Boulet SL;Crawford S;Zhang Y;Sunderam S;Cohen B;Bernson D;McKane P;Bailey MA;Jamieson DJ;Kissin DM;States Monitoring ART Collaborative
使用相关的辅助生殖技术（ART）监测和出生证明数据，比较ET实践和围产期结局，对于需要覆盖IVF服务的全面授权的州与没有授权的州。回顾性队列研究。不适用因根据2007-2009年国家抗逆转录病毒药物监测系统和出生证明数据，确定了一个有保险授权的州（马萨诸塞州）和两个没有授权的州（佛罗里达和密歇根州）的活产分娩情况。没有。移植的胚胎数量，多胞胎，低出生体重，早产。在委任统治州的230 038次分娩和非委任统治州的1 026 804次分娩中，（2.9%）和8，417移植三个或三个以上胚胎在非强制性州更为常见，尽管对35岁或35岁以上妇女的影响有所减弱（33.6% vs. 39.7%;校正相对风险[RR]，1.46; 95%置信区间[CI]，1.17-1.81）与35岁以下女性（7.0% vs. 26.9%;校正RR，4.18; 95% CI，2.74-6.36）。缺乏保险授权与三重/更高订单的交付呈正相关（1.0% vs. 2.3%;校正RR，2.44; 95% CI，1.81-3.28），早产（22.6% vs. 30.7%;调整后RR，1.31; 95% CI，1.20-1.42）和低出生体重（22.3% vs. 29.5%;调整后RR，1.28; 95% CI，1.17-1.40）。与非授权州相比，授权州有更高的抗逆转录病毒治疗使用率。在ART分娩中，缺乏不孕症保险规定与不良围产期结局风险增加相关。
To use linked assisted reproductive technology (ART) surveillance and birth certificate data to compare ET practices and perinatal outcomes for a state with a comprehensive mandate requiring coverage of IVF services versus states without a mandate. Retrospective cohort study. Not applicable. Live-birth deliveries ascertained from linked 2007–2009 National ART Surveillance System and birth certificate data for a state with an insurance mandate (Massachusetts) and two states without a mandate (Florida and Michigan). None. Number of embryos transferred, multiple births, low birth weight, preterm delivery. Of the 230,038 deliveries in the mandate state and 1,026,804 deliveries in the nonmandate states, 6,651 (2.9%) and 8,417 (0.8%), respectively, were conceived by ART. Transfer of three or more embryos was more common in nonmandate states, although the effect was attenuated for women 35 years or older (33.6% vs. 39.7%; adjusted relative risk [RR], 1.46; 95% confidence interval [CI], 1.17–1.81) versus women younger than 35 (7.0% vs. 26.9%; adjusted RR, 4.18; 95% CI, 2.74–6.36). Lack of an insurance mandate was positively associated with triplet/higher order deliveries (1.0% vs. 2.3%; adjusted RR, 2.44; 95% CI, 1.81–3.28), preterm delivery (22.6% vs. 30.7%; adjusted RR, 1.31; 95% CI, 1.20–1.42), and low birth weight (22.3% vs. 29.5%; adjusted RR, 1.28; 95% CI, 1.17–1.40). Compared with nonmandate states, the mandate state had higher overall rates of ART use. Among ART births, lack of an infertility insurance mandate was associated with increased risk for adverse perinatal outcomes.