SUCCESSFUL BUT NOT SIMPLE: OBSTETRIC MORBIDITY AMONG ASSISTED REPRODUCTIVE TECHNOLOGY (ART) SINGLETON PREGNANCIES

Objective To evaluate obstetric outcomes among singleton pregnancies conceived with assisted reproductive technology (ART) compared with non-ART singleton pregnancies at the national level. Design Retrospective population-based cohort study. Materials and Methods Using CDC WONDER Natality expanded files (2016–2019), we identified U.S. singleton births conceived with and without ART. Outcomes included preterm birth (<37 weeks), hypertensive disorders of pregnancy, gestational diabetes mellitus (GDM), and cesarean delivery. Rates were calculated annually and compared using chi-square testing. Results Among singleton births, ART-conceived pregnancies demonstrated persistently higher cesarean delivery rates compared with non-ART pregnancies (~48% vs 38–39%; absolute difference ~9–10 percentage points; all p<0.001). Preterm birth was modestly more frequent among ART singleton pregnancies (p<0.001). In contrast, hypertensive disorder rates were similar between groups across study years (p>0.05). GDM prevalence ranged from 9.99–10.91% among ART singleton births and 10.10–11.54% among non-ART singleton births, with no significant difference observed (p>0.05). Conclusions Even among singleton pregnancies, ART conception is associated with higher cesarean delivery and modestly increased preterm birth rates at the national level. However, hypertensive disorders and gestational diabetes appear comparable between ART and non-ART singleton pregnancies in the contemporary ART era. These findings suggest that successful ART singleton pregnancies may carry a distinct—but not uniformly elevated—obstetric morbidity profile.