Massachusetts Outcomes Study of Assisted Reproductive Technology Equity

Project Summary Given the persistently stark racial/ethnic 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 apply a health equity framework to investigate the experiences and outcomes of women of color 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 racial/ethnic disparities among non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, Non-Hispanic Asian (NHA) and other groups 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 birthing people and their infants). We will also test whether the magnitude of racial/ethnic disparities in the ART group varies from fertile and subfertile populations. 2) Among NHW, NHB, and Hispanic women who receive ART or other fertility treatments

and their infants, we will investigate the impact of racism and other 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 NHB and Hispanic 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 relative to their NHW counterparts with a focus on the experience of racism. 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 equitable perinatal healthcare to those accessing and receiving ART and other fertility treatments.