Factors associated with large-for-gestational-age infants born after frozen embryo transfer cycles
Anne J. Roshong, M.D.,
Carol E. DeSantis, M.P.H.,
Anthony K. Yartel, M.P.H.,
Ryan J. Heitmann, D.O.,
Dmitry M. Kissin, M.D., M.P.H.,
Bruce D. Pier, M.D.
Affiliations
Anne J. Roshong, M.D.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington
Carol E. DeSantis, M.P.H.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; CDC Foundation, Atlanta, Georgia
Anthony K. Yartel, M.P.H.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; CDC Foundation, Atlanta, Georgia
Ryan J. Heitmann, D.O.
West Virginia University Center for Reproductive Medicine, Department of Obstetrics and Gynecology, West Virginia University School of Medicine, Morgantown, West Virginia
Dmitry M. Kissin, M.D., M.P.H.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Bruce D. Pier, M.D.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington; Reprint requests: Bruce D. Pier, M.D., Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma Washington.
Objective: To examine trends of frozen embryo transfer (FET) proportions and large-for-gestational-age (LGA) incidence and determine risk factors for LGA infants after FET. Design: Retrospective cohort study. Setting: Not applicable. Patient(s): Frozen embryo transfer cycles. Intervention(s): None. Main Outcome Measure(s): Singleton LGA infant. Result(s): The percentage of FETs increased from 20%–74% of transfers, whereas the rate of LGA among FET singleton births decreased from 18%–12% during 2004–2018. In a subanalysis of 127,525 FET-associated singleton live births during 2016–2018, patient factors associated with LGA were higher-than-normal maternal body mass index (body mass index [BMI], 25.0–29.9 kg/m2; adjusted relative risk [aRR], 1.31; 95% confidence interval [CI], 1.26–1.36; BMI, 30.0–34.9 kg/m2; aRR, 1.48; 95% CI, 1.41–1.55; and BMI, >35 Kg/m2; aRR, 1.68; 95% CI, 1.59–1.77) and ≥1 prior birth vs. none. Low maternal BMI (<18.5 vs. 18.5–24.9 kg/m2) and cycles involving patients who were non-Hispanic (NH) Asian/Native Hawaiian/Pacific Islander, NH Black, or Hispanic (compared with NH White) were at lower risk of LGA infants. Cycle factors associated with LGA included gestational carrier use (aRR, 1.25; 95% CI, 1.16–1.34) and donor sperm (aRR, 1.17; 95% CI, 1.10–1.25). Conclusion(s): Although the number and proportion of FET cycles increased from 2004–2018, the rate of LGA after FET decreased. Maternal BMI, parity, and race/ethnicity were the strongest risk factors for LGA infants after FET.
