Abstract
PURPOSE: To determine whether an association exists between in vitro fertilization (IVF) and severe neonatal morbidity. Secondary objectives were to assess 1) the association between donor oocytes and severe neonatal morbidity, 2) whether respiratory-related versus non-respiratory severe neonatal morbidity differs by IVF status, and 3) antenatal steroid administration rates between cohorts. METHODS: Retrospective cohort study of live singleton deliveries between 01/2019-12/2023 within an academic health system. The primary outcome was severe neonatal morbidity, a composite measure adapted from the Neonatal Adverse Outcome Indicator (NAOI), incorporating selected diagnoses (e.g., intraventricular hemorrhage, sepsis) and procedures (e.g., mechanical ventilation, blood transfusion) that represent life-threatening neonatal complications. The secondary outcome was the need for antepartum steroid administration. Mixed effects multivariable logistic regression modeled the association between IVF and severe neonatal morbidity, adjusting for covariates. Odds ratios (ORs), and their associated 95% confidence interval (CIs) were computed; p < 0.05 was considered statistically significant. RESULTS: Among 46,761 pregnancies delivered at > 32 weeks gestation, 2,327 conceived via IVF. Severe neonatal morbidity occurred in 10.5% (n = 245) in the IVF group, compared to 6.9% (n = 3,079) in the non-IVF group (OR 1.70, 95% CI: 1.48-1.95; aOR 1.42, 95% CI: 1.23-1.66). CONCLUSION: IVF-conceived infants are more likely to experience severe neonatal morbidity. Future studies should investigate mechanisms underlying these associations to guide counseling and optimize care.