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Background: Research has shown an association between assisted reproductive technology (ART) and adverse birth outcomes. We identified whether birth outcomes of ART-conceived pregnancies vary across states with different maternal characteristics, insurance coverage for ART services, and type of ART services provided.Methods: CDC's National ART Surveillance System data were linked to Massachusetts, Florida, and Michigan vital records from 2000 through 2006. Maternal characteristics in ART- and non-ART-conceived live births were compared between states using chi-square tests. We performed multivariable logistic regression analyses and calculated adjusted odds ratios (aOR) to assess associations between ART use and singleton preterm delivery (<32 weeks, <37 weeks), singleton small for gestational age (SGA) (<5th and <10th percentiles) and multiple birth.Results: ART use in Massachusetts was associated with significantly lower odds of twins as well as triplets and higher order births compared to Florida and Michigan (aOR 22.6 vs. 30.0 and 26.3, and aOR 37.6 vs. 92.8 and 99.2, respectively; Pinteraction < 0.001). ART use was associated with increased odds of SGA in Michigan only, and with preterm delivery (<32 and <37 weeks) in all states (aOR range: 1.60, 1.87).Conclusions: ART use was associated with an increased risk of preterm delivery among singletons that showed little variability between states. The number of twins, triplets and higher order gestations per cycle was lower in Massachusetts, which may be due to the availability of insurance coverage for ART in Massachusetts. [ABSTRACT FROM AUTHOR]

Background Assisted Reproductive Technology ( ART) includes fertility procedures where both egg and sperm are handled in the lab. ART use has increased considerably in recent years, accounting for 47 090 livebirths in the US in 2010. ART increases the probability of multiple gestation births, which are at higher risks than singletons for adverse outcomes. Additionally, ART is associated with a greater risk of complications during pregnancy, labour, and delivery, and increased risk of adverse perinatal outcomes in singleton births. Methods We merged Florida and Massachusetts birth records from 2004-06 with the National ART Surveillance System ( NASS) and using NASS as the gold standard, calculated sensitivity, specificity, and positive predictive value ( PPV) of ART reporting on the birth certificates by maternal, infant, and hospital characteristics. We fit random-effects logistic regression models to evaluate simultaneously the association of ART reporting with these predictors while accounting for correlation among births occurring in the same hospital. Results Sensitivity of ART reporting on the birth certificate was 28.9% in Florida and 41.4% in Massachusetts. Specificity was >99% in both states. PPV was 45.5% in Florida and 54.6% in Massachusetts. The odds of ART reporting varied by state and by several maternal and delivery characteristics including age, parity, history of fetal loss, plurality, race/Hispanic ethnicity, delivery payment source, pre-existing conditions, and complications during pregnancy or labour and delivery. Conclusions There was significant under-reporting of ART procedures on the birth certificates. Using data on ART births identified only from birth certificates yields a biased sample of the population of ART births. [ABSTRACT FROM AUTHOR]

Background Auditory hallucinations (AH) are most commonly associated with schizophrenia (SZ), but they are non-specific, also occurring in up to 48% of bipolar disorder (BP) patients. It is well-established that SZ and BP, especially BP with psychotic features, are syndromes with significant genetic and clinical overlap. Despite how common auditory hallucinations are in BP, the neuroimaging literature on the topic is sparse. Many groups have studied abnormalities of resting state functional connectivity (FC) associated with AH in schizophrenia, but to our knowledge there are no published studies to date of FC associated with auditory hallucinations in BP. In this transdiagnostic investigation, we sought to identify functional connectivity (FC) abnormalities associated with AH across the spectrum of psychosis, including SZ and BP. Methods Participants were 93 individuals with lifetime AH (69 SZ, 24 BP) and 63 without (NAH) (17 SZ, 46 BP), categorized using item B16 in the Structured Clinical Interview for DSM-IV-TR (SCID), which asks about lifetime auditory hallucinations. We acquired high-resolution structural scans and resting state blood oxygenation level dependent (BOLD) images (124 volumes, TR/TE 3000ms/30ms) on a 3T Siemens Tim Trio scanner at McLean Hospital. We used CONN v17e for resting state FC analysis. In addition to standard preprocessing, we used the ARtifact detection Tool (ART) to identify outlier time points, included only individuals with < 20 motion outliers, and performed rigorous denoising. For group-level analysis, we compared AH to NAH, adjusting for motion and other symptom dimensions. We performed ROI-to-ROI analysis, looking at BOLD time-course correlations across the 48 cortical and 21 subcortical regions of the Harvard-Oxford atlas and 26 cerebellar regions from the Automated Anatomical Labeling (AAL) atlas, using a significance threshold of p<0.05, FDR-corrected. As diagnosis, hallucinations in other (non-auditory) modalities, negative symptom severity, mania severity, and depression severity were statistically significantly different between AH and NAH, we controlled for these factors, in addition to motion, in our FC analysis. Results We found that patients with auditory hallucinations had increased cerebello-cerebral cortical and cerebello-subcortical connectivity, compared to patients who have never had auditory hallucinations. In particular, we found hyperconnectivity between cerebellar subregions and frontal (left precentral gyrus, bilateral orbitofrontal cortices, and left inferior frontal gyrus), temporal (right middle temporal gyrus, bilateral planum temporale, right Heschl's gyrus, and bilateral fusiform cortices), parietal (left superior parietal lobule and bilateral parietal opercula), and subcortical regions (left nucleus accumbens and left thalamus). Conclusions Our findings of aberrant cerebello-cerebral cortical and cerebello-subcortical connectivity are intriguing in light of growing evidence for the role of the cerebellum in integrating higher-level brain processes as well as for cerebellar abnormalities in both SZ and psychotic BP. Abnormal connectivity involving the cerebellum may play a more central role in the pathophysiology of AH than described in leading models of AH. [ABSTRACT FROM AUTHOR]

Objective: 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., Design: Retrospective cohort study., Setting: Not applicable., Patient(s): 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)., Intervention(s): None., Main Outcome Measure(s): Number of embryos transferred, multiple births, low birth weight, preterm delivery., Result(s): 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)., Conclusion(s): 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., (Published by Elsevier Inc.)

Assisted reproductive technology (ART) refers to fertility treatments in which both eggs and sperm are handled outside the body. The Centers for Disease Control and Prevention (CDC) oversees the National ART Surveillance System (NASS), which collects data on all ART procedures performed in the United States. The NASS, while a comprehensive source of data on ART patient demographics and clinical procedures, includes limited information on outcomes related to women's and children's health. To examine ART-related health outcomes, CDC and three states (Massachusetts, Florida, and Michigan) established the States Monitoring ART (SMART) Collaborative to evaluate maternal and perinatal outcomes of ART and improve state-based ART surveillance. To date, NASS data have been linked with states' vital records, disease registries, and hospital discharge data with a linkage rate of 90.2%. The probabilistic linkage methodology used in the SMART Collaborative has been validated and found to be both accurate and efficient. A wide breadth of applied research within the Collaborative is planned or ongoing, including examinations of the impact of insurance mandates on ART use as well as the relationships between ART and birth defects and cancer, among others. The SMART Collaborative is working to improve state-based ART surveillance by developing state surveillance plans, establishing partnerships, and conducting data analyses. The SMART Collaborative has been instrumental in creating linked datasets and strengthening epidemiologic and research capacity for improving maternal and infant health programs and evaluating the public health impact of ART.