Massachusetts Outcomes Study of Assisted Reproductive Technology Equity

PROJECT SUMMARY Given the persistent disparities in perinatal health outcomes in the U.S. and the increasing utilization of fertility treatment to achieve pregnancy, the overall goal of this study is to investigate the experiences and outcomes of women from various demographic backgrounds who receive fertility treatment and achieve a live birth. Our specific aims are: 1) For fertile, subfertile, and assisted reproductive technology (ART) groups, we will quantify disparities among women in (a) maternal morbidity (based upon Centers for Disease Control and Prevention definition) and mortality during birth hospitalization through the first year postpartum and (b) infant health outcomes at birth and through the first year of life (e.g. mortality, re-hospitalizations, and emergency room use) through analysis of the population based Massachusetts Outcome Study of Assisted Reproductive Technology (MOSART) data system from 2004-2020, which includes data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) and the MA Pregnancy to Early Life Longitudinal (PELL) data system (an ongoing longitudinally-linked population-based system that includes birth certificates, death records, and hospital utilization data for MA women and their infants). 2) Among women who receive ART or other fertility treatments and their infants, we will investigate the impact of individual-, healthcare-, and community-level factors associated with adverse perinatal health outcomes, through linkages of the MA Pregnancy Risk Assessment Monitoring System (PRAMS) with the MA PELL data system. PRAMS collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy with specific questions pertaining to receipt of fertility treatment. 3) Through qualitative interviews with women who have received fertility treatment and a live birth, we will identify facilitators and barriers to successful navigation of fertility treatment and subsequent maternal and infant care that may lead to excess risk for adverse maternal and infant health outcomes. This proposal will provide a comprehensive investigation using quantitative and qualitative methods that will inform the development of future policies and programs aimed at providing high quality perinatal healthcare to those accessing and receiving ART and other fertility treatments.