The impact of reference growth standards on small- and large-for-gestational age outcomes among pregnancies conceived by fresh and frozen embryo transfers
Sunidhi Singh, M.D.,
Pietro Bortoletto, M.D., M.Sc.,
Blair J. Wylie, M.D., M.P.H.,
Alexis P. Melnick, M.D.,
Malavika Prabhu, M.D.
Affiliations
Sunidhi Singh, M.D.
Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
Pietro Bortoletto, M.D., M.Sc.
The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York; Boston IVF, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Blair J. Wylie, M.D., M.P.H.
Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
Alexis P. Melnick, M.D.
The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
Malavika Prabhu, M.D.
Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Correspondence: Malavika Prabhu, M.D., Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114.
Objective: To describe differences in the frequency of small-for-gestational age (SGA) and large-for-gestational age (LGA) driven by different birth weight curves in assisted reproductive technology (ART)–conceived pregnancies. Design: Retrospective cohort study. Setting: Single academic medical center. Patients: Singleton live births between the gestational ages of 36 weeks and 0 days and 42 weeks and 6 days from fresh or frozen embryo transfer (ET). Intervention(s): None. Main Outcome Measure(s): SGA (90th percentile) classified by Fenton, INTERGROWTH-21, World Health Organization, Duryea, and Oken curves. Results: The median birth weight and gestational age at birth among fresh ET pregnancies were 3,289g (interquartile range [IQR], 2,977–3,600g) and 39.4 (IQR, 38.6–40.3) weeks, respectively, and those among frozen ET pregnancies were 3,399g (IQR, 3,065–3,685g) and 39.4 (IQR, 38.7–40.1) weeks, respectively. The frequencies of SGA neonates using each birth weight standard ranged from 5.8% to 13.4% for fresh ET and from 3.5% to 8.7% for frozen ET. Those of LGA neonates ranged from 5.3% to 14.3% for fresh ET and from 6.6% to 21.2% for frozen ET. Conclusion: The frequency of SGA and LGA neonates among ART-conceived gestations is partially driven by the birth weight standard. Selecting an appropriate standard that best reflects the patient population is critical to quantifying the risk of ART-conceived pregnancies.
