Factors associated with large-for-gestational-age infants born after frozen embryo transfer cycles

Anne J Roshong; Carol E DeSantis; Anthony K Yartel; Ryan J Heitmann; Dmitry M Kissin; Bruce D Pier

doi:10.1016/j.xfre.2022.09.002

Factors associated with large-for-gestational-age infants born after frozen embryo transfer cycles

F S Rep. 2022 Sep 9;3(4):332-341. doi: 10.1016/j.xfre.2022.09.002. eCollection 2022 Dec.

Authors

Anne J Roshong¹, Carol E DeSantis^{2

3}, Anthony K Yartel^{2

3}, Ryan J Heitmann⁴, Dmitry M Kissin², Bruce D Pier¹

Affiliations

¹ Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington.
² Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
³ CDC Foundation, Atlanta, Georgia.
⁴ West Virginia University Center for Reproductive Medicine, Department of Obstetrics and Gynecology, West Virginia University School of Medicine, Morgantown, West Virginia.

Abstract

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.

Patients: Frozen embryo transfer cycles.

Interventions: None.

Main outcome measures: Singleton LGA infant.

Results: 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).

Conclusions: 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.

Keywords: Frozen embryo transfer; in vitro fertilization; large-for-gestational-age; obstetric outcomes.