{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:00:52Z","timestamp":1753876852671,"version":"3.41.2"},"reference-count":31,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2020,11,26]],"date-time":"2020-11-26T00:00:00Z","timestamp":1606348800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Public Health Agency of Canada. N.A"},{"name":"Fonds de recherche du Qu\u00e9bec-Sant\u00e9","award":["34695"],"award-info":[{"award-number":["34695"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>STUDY QUESTION<\/jats:title>\n                  <jats:p>Does publicly funded assisted reproductive technology result in improved maternal and infant outcomes?<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>SUMMARY ANSWER<\/jats:title>\n                  <jats:p>Publicly funded ART in Quebec was associated with reduced risks of preeclampsia, cesarean delivery, preterm birth, low birth weight and other adverse outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>WHAT IS KNOWN ALREADY<\/jats:title>\n                  <jats:p>Publicly funded ART programs that provide free access to single embryo transfer are known to decrease the rate of multiple pregnancy, but the impact on other pregnancy outcomes is unknown.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>STUDY DESIGN, SIZE, DURATION<\/jats:title>\n                  <jats:p>We conducted a pre- and post-comparison study of 597\u00a0416 pregnancies conceived between July 2008 and September 2015 in Quebec, Canada, a region where public funding of ART began in August 2010.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PARTICIPANTS\/MATERIALS, SETTING, METHODS<\/jats:title>\n                  <jats:p>We included all pregnant women who conceived by ART (n\u2009=\u200914\u00a0309) or spontaneously (n\u2009=\u2009583\u00a0107) and delivered a live or stillborn infant in hospitals of Quebec. The main exposure measure was conception before versus during the publicly funded ART program. Outcomes included measures of maternal and infant morbidity and mortality. We estimated risk ratios (RR) and 95% confidence intervals for the association of publicly funded ART with maternal and infant outcomes using log-binomial regression models adjusted for maternal characteristics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>MAIN RESULTS AND THE ROLE OF CHANCE<\/jats:title>\n                  <jats:p>In this study, 2638 pregnancies were conceived by ART before, and 11\u00a0671 were conceived by ART, during public funding. Compared with no public funding, ART funding was associated with reduced risks of severe maternal morbidity (RR 0.64, 95% CI 0.50\u20130.83), preeclampsia (RR 0.55, 95% CI 0.44\u20130.68), cesarean delivery (RR 0.83, 95% CI 0.77\u20130.89), preterm birth (RR 0.67, 95% CI 0.60\u20130.75), low birth weight (RR 0.63, 95% CI 0.55\u20130.72), severe neonatal morbidity (RR 0.75, 95% CI 0.57\u20130.99) and neonatal intensive care unit admission (RR 0.65, 95% CI 0.53\u20130.78). When multiple pregnancies were excluded, ART funding continued to be associated with a lower risk of preeclampsia (RR 0.61, 95% CI 0.48\u20130.79) and preterm birth (RR 0.85, 95% CI 0.73\u20130.99). However, ART funding was associated with increased risk of gestational diabetes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>LIMITATIONS, REASONS FOR CAUTION<\/jats:title>\n                  <jats:p>We had no information on the type of ART, number of in-vitro fertilization cycles or number of embryos transferred. We lacked data on body mass index, ethnicity and smoking and cannot rule out residual confounding.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>WIDER IMPLICATION OF THE FINDINGS<\/jats:title>\n                  <jats:p>Our findings suggest that publicly funded ART programs that encourage single embryo transfer may have substantial benefits for a range of maternal and infant outcomes, beyond prevention of multiple births.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>STUDY FUNDING\/COMPETING INTEREST(S)<\/jats:title>\n                  <jats:p>This study was supported by grant 6D02363004 from the Public Health Agency of Canada. N.A. acknowledges a career award from the Fonds de recherche du Qu\u00e9bec-Sant\u00e9 (34695). The authors declare no competing interests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>TRIAL REGISTRATION NUMBER<\/jats:title>\n                  <jats:p>N\/A<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/humrep\/deaa270","type":"journal-article","created":{"date-parts":[[2020,9,22]],"date-time":"2020-09-22T03:42:52Z","timestamp":1600746172000},"source":"Crossref","is-referenced-by-count":1,"title":["Effect of publicly funded assisted reproductive technology on maternal and infant outcomes: a pre- and post-comparison study"],"prefix":"10.1093","author":[{"given":"Shu Qin","family":"Wei","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Canada"},{"name":"Bureau d\u2019information et d\u2019\u00e9tudes en sant\u00e9 des populations, Institut national de sant\u00e9 publique du Qu\u00e9bec, Montreal, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianne","family":"Bilodeau-Bertrand","sequence":"additional","affiliation":[{"name":"Bureau d\u2019information et d\u2019\u00e9tudes en sant\u00e9 des populations, Institut national de sant\u00e9 publique du Qu\u00e9bec, Montreal, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ernest","family":"Lo","sequence":"additional","affiliation":[{"name":"Bureau d\u2019information et d\u2019\u00e9tudes en sant\u00e9 des populations, Institut national de sant\u00e9 publique du Qu\u00e9bec, Montreal, Canada"},{"name":"Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathalie","family":"Auger","sequence":"additional","affiliation":[{"name":"Bureau d\u2019information et d\u2019\u00e9tudes en sant\u00e9 des populations, Institut national de sant\u00e9 publique du Qu\u00e9bec, Montreal, Canada"},{"name":"Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada"},{"name":"Department of Social and Preventive Medicine, School of Public Health, University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,11,26]]},"reference":[{"key":"2020112717064706400_deaa270-B1","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/j.rbmo.2011.05.020","article-title":"Working to eliminate multiple pregnancies: a success story in Qu\u00e9bec","volume":"23","author":"Bissonnette","year":"2011","journal-title":"Reprod Biomed Online"},{"key":"2020112717064706400_deaa270-B2","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.rbms.2019.01.002","article-title":"Impact of government health coverage for ART: the results of a 5-year experience in Quebec","volume":"8","author":"Bissonnette","year":"2019","journal-title":"Reprod Biomed Soc Online"},{"key":"2020112717064706400_deaa270-B3","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1186\/1472-6963-12-142","article-title":"A reduction in public funding for fertility treatment\u2014an econometric analysis of access to treatment and savings to government","volume":"12","author":"Chambers","year":"2012","journal-title":"BMC Health Serv Res"},{"key":"2020112717064706400_deaa270-B4","doi-asserted-by":"crossref","first-page":"594","DOI":"10.5694\/mja10.11448","article-title":"Assisted reproductive technology: public funding and the voluntary shift to single embryo transfer in Australia","volume":"195","author":"Chambers","year":"2011","journal-title":"Med J Aust"},{"key":"2020112717064706400_deaa270-B5","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1111\/ppe.12574","article-title":"Severe maternal morbidity surveillance: monitoring pregnant women at high risk for prolonged hospitalisation and death","volume":"34","author":"Dzakpasu","year":"2020","journal-title":"Paediatr Perinat Epidemiol"},{"key":"2020112717064706400_deaa270-B6","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1093\/humrep\/16.4.790","article-title":"Prevention of twin pregnancies after IVF\/ICSI by single embryo transfer. 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