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Impact of ART on pregnancies in California: an analysis of maternity outcomes and insights into the added burden of neonatal intensive care

A Corrigendum to this article was published on 31 October 2014



We reviewed the occurrence of prematurity, low birth weight, multiple gestations, frequency of stillbirths and maternity care-associated variables including hospital stay and hospital charges of women conceiving using assisted reproductive technology (ART) or artificial insemination (AI) compared with women with a history of infertility who conceived naturally, and all other naturally conceived pregnancies in California at non-federal hospitals between 2009 and 2011. At a single center, infants born after ART/AI were compared with infants provided care in the normal nursery.

Study design:

Publically available inpatient data sets from the California Office of Statewide Health Planning and Development for years 2009–2011 using data from all California non-federal hospitals were used to determine the impact of ART on a variety of pregnancy-related outcomes and infant characteristics. Infant data from a single center was used to determine hospital charges for infants delivered over an 18-month period to compare the hospital and physician charges indexed to similar charges for infants admitted to the ‘normal’ newborn nursery.


Among ART/AI pregnancies, there was a 4–5-fold increase in stillbirths, compared with a 2–3-fold increase among women with infertility compared with other naturally conceiving women. ART/AI pregnancies underwent more cesarean sections (fourfold), and a near fourfold increase in the rate of preterm deliveries. Multiple gestations were increased 24–27-fold compared with naturally conceived pregnancies. Maternal hospital stay and hospital charges were increased among those undergoing ART/AI. Infant charges were increased multi-fold for singletons, twins and triplets delivered after ART/AI compared with naturally conceived infants.


Multiple births, preterm births and a higher overall rate of fetal anomalies were found in California after ART/AI for 2009–2011. Cesarean section rates, longer length of maternal stay and hospital charges among women receiving ART/AI could be lowered if emphasis on elective single embryo transfers was a higher priority among providers. Charges for the care of infants delivered after ART/AI are substantially higher than among naturally conceived infants born late preterm or at term. Families seeking ART/AI need to be informed of the impact of these adverse pregnancy outcomes, including neonatal outcomes and charges for medical care for their infant(s), when considering ART/AI.

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Appreciation is expressed to the hospital financial auditing department of Loma Linda University Medical Center and to Department financial auditors. This study was funded, in part, from a community services grant from Medimmune to the Perinatal Advocacy Committee of Greater Los Angeles.

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Correspondence to T A Merritt.

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Merritt, T., Goldstein, M., Philips, R. et al. Impact of ART on pregnancies in California: an analysis of maternity outcomes and insights into the added burden of neonatal intensive care. J Perinatol 34, 345–350 (2014).

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