The effect of trophectoderm biopsy for preimplantation genetic testing on fetal birth weight and preterm delivery.

BACKGROUND: Preimplantation genetic testing for aneuploidy (PGT-A) is used as part of in-vitro-fertilization (IVF) to assist in selection of euploid embryos, which involves performing trophectoderm biopsy. The effect of possible trauma caused by biopsy and the implication on pregnancy is unknown. Hence, the objective of the study was to determine if embryo biopsy for PGT-A affects birth weight or preterm birth rate. METHODS: Using National Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) data, we identified 6352 cycles which had single embryo transfer (SET) and a singleton live birth following frozen embryo transfer (FET) between 2014 and 2015. RESULTS: From the initial cohort of 25,121 fresh stimulation cycles, 6352 cycles were included who had a singleton live birth following FET. A total of 3482 (54.8%) had PGT-A confirmed euploid embryos and 2870 (45.2%) had embryos selected based on morphology for transfer. No difference in birthweight (g) was noted when FET was performed using PGT-A confirmed euploid embryos as compared to non-tested morphologically selected embryos (3370.7 vs. 3354.5, adjusted regression coefficient 11.4; 95% CI: -12.6; 35.3). As compared to morphologically selected embryos, performance of PGT-A did not increase the risk of small for gestation age (SGA) (3.9% vs. 4.1%, OR: 1.13; 95% CI: 0.86-1.50), low birth weight (LBW) (<2500 g but ≥1500 g) (5.8% vs. 5.5%, OR: 0.90; 95% CI: 0.66-1.21), or very low birthweight (<1500 g) (1.3% vs. 1.0%, OR: 0.44; 95% CI: 0.44 (0.18-1.10). There was no increased risk of preterm birth (PTB) associated with pregnancy resulting from PGT-A embryos vs. non PGT-A embryos (15.8% vs. 16.4%, OR: 0.94; 95% CI: 0.81-1.09). CONCLUSIONS: In our study, trophectoderm biopsy for PGT-A did not increase the risk of SGA, LBW or PTB in IVF pregnancies.

Survival and healthcare utilization of infants diagnosed with lethal congenital malformations.

OBJECTIVE: We assessed survival, hospital length of stay (LOS), and costs of medical care for infants with lethal congenital malformations, and also examined the relationship between medical and surgical therapies and survival. STUDY DESIGN: Retrospective cohort study including infants born 1998-2009 with lethal congenital malformations, identified using a longitudinally linked maternal/infant database. RESULTS: The cohort included 786 infants: trisomy 18 (T18, n = 350), trisomy 13 (T13, n = 206), anencephaly (n = 125), bilateral renal agenesis (n = 53), thanatophoric dysplasia/achondrogenesis/lethal osteogenesis imperfecta (n = 38), and infants > 1 of the birth defects (n = 14). Compared to infants without birth defects, infants with T18, T13, bilateral renal agenesis, and skeletal dysplasias had longer survival rates, higher inpatient medical costs, and longer LOS. CONCLUSION: Care practices and survival have changed over time for infants with T18, T13, bilateral renal agenesis, and skeletal dysplasias. This information will be useful for clinicians in counseling families and in shaping goals of care prenatally and postnatally.

Anterior cruciate ligament injury and access to care in South Florida: does insurance status play a role?

BACKGROUND: Health insurance status and access to care are recurring topics of discussion and concern. The purpose of this investigation was to examine access to care on the basis of insurance status for patients with anterior cruciate ligament (ACL) injuries in South Florida. METHODS: From March 2010 to March 2011, eighty patients with ACL injuries were identified at a county hospital sports medicine clinic and a university-based sports medicine practice. Demographic and injury-specific data were obtained with attention to the date of injury, the date of diagnosis, and the number of medical visits. Hazard ratios and 95% confidence intervals were calculated from multivariable Cox proportional-hazards regression models to determine the effect of insurance type on the time to diagnosis of an ACL tear. RESULTS: Patients with private insurance were diagnosed at a median fourteen days after the injury, whereas those receiving Medicaid and those without insurance were diagnosed a median of fifty-six and 121 days after the injury, respectively (p < 0.001). Patients without insurance and those receiving Medicaid had more medical visits prior to diagnosis (median, four; range two to six) than those with private insurance (median, three; range, one to five) (p = 0.006). Differences for patient delays due to not seeking care were not significant among the three groups (p = 0.484). CONCLUSIONS: When grouped according to insurance status, subjects receiving Medicaid in South Florida faced greater system-related delays in obtaining care than did subjects with private insurance. System-related factors such as lack of access to specialized care result in an increased number of medical encounters. These regional findings are consistent with those of other regional studies on access to orthopaedic care.