It has been well-known in research that Black babies are about twice as likely to die as White babies before their first birthday. Now, a new study suggests that that disparity is even larger when babies are conceived by in vitro fertilization or other forms of assisted reproductive technology.
The study, published Wednesday in the journal Pediatrics, found that when they are conceived naturally, neonatal mortality is two-fold higher among Black infants than Whites. But when conceived by assisted reproductive technology, neonatal mortality was more than four-fold higher among babies of Black women.
The researchers were interested in what that disparity in infant mortality would look like “in a group of women that would be relatively affluent,” said Dr. Sarka Lisonkova, an author of the study and associate professor in the Department of Obstetrics and Gynaecology and the Children’s and Women’s Hospital of British Columbia in Vancouver.
Lisonkova said she thought the racial disparities among the babies of women using assisted reproductive technology would be smaller, “just based on the fact that the socioeconomic disparities wouldn’t be that large,” she said.
Certain socioeconomic disparities – such as not having equitable access to infant care or not having health insurance – can drive higher rates of neonatal death. But since fertility treatments can be expensive, Lisonkova assumed there would not be large socioeconomic differences among the women undergoing the treatment and, as a result, no large differences in infant mortality outcomes.
Assisted reproductive technology, which is used to treat infertility, includes infertility treatments that involve eggs and sperm. The most common type is IVF, which can be very expensive. Each cycle can cost $12,000 to $17,000, according to the National Conference of State Legislatures.
Lisonkova was surprised by the results of the new study: The disparities in infant mortality grew instead of receded when examined only among babies of women undergoing assisted reproductive technology.
Socioeconomic differences appear to remain among women undergoing infertility treatments, which could be driving these disparities, Lisonkova said.
“It seems that there are still socioeconomic disparities, even in this particular group of relatively more affluent and educated women who usually tend to go through the fertility treatments,” she said. “So there could still be residual confounding by socioeconomic status. The other thing is that there might be differential access to health services, particular in this case of obstetric and maternity care services, and neonatal health services.”
Disparities in death rates
The study, conducted by researchers in Canada, included data on more than 7.5 million babies born in the United States from 2016 to 2017, among which 93,469 were conceived by medically assisted reproduction. The researchers examined data from birth and death certificates obtained from the National Center for Health Statistics, taking a close look at outcomes of neonatal death, defined as death within an infant’s first 28 days.
The data showed that newborn babies of Black versus White mothers who conceived on their own had a two-fold higher rate of neonatal death. Those rates were four-fold higher in infants of Black versus White mothers who used assisted reproductive technology, such as IVF.
Racial disparities were also significantly larger among Asian and Pacific Islander and Hispanic women, as both had 1.9-fold higher rate of neonatal death when assisted reproductive technology was used. During spontaneous conception, Asian and Pacific Islanders have a 10% lower rate of infant death than White women.
“I was really surprised, to be honest,” Lisonkova said of the overall findings. “The relative risks are quite high.”
However, she doesn’t want the study to discourage Black, Hispanic, or Asian and Pacific Islander people from pursuing assisted reproduction. She advises people to have a childbirth plan and to continuously consult and follow up with their doctors.
“Do not hesitate if you feel uncomfortable,” she said, “or if you feel something is not going right, consult with your physician.”
Lisonkova also recommends that health-care providers maintain good surveillance of babies and their health after birth. She said providers have a responsibility to listen to women and provide more access to neonatal care.
“This study should send shock waves through fertility centers, ob-gyn clinics and high risk ob-gyn clinics everywhere,” Dr. Aimee Eyvazzadeh, a San Francisco-based reproductive endocrinologist who was not involved in the new study, said in an email to CNN.
“Anyone who uses medically assisted reproduction to get pregnant should be designated as a high-risk pregnancy and get additional monitoring during pregnancy and especially after. The complications this study describes are simply unacceptable and interventions need to be put in place even before treatment is initiated,” she wrote. “This study tells me that our work is not over. We need to work even harder to improve maternal and neonatal outcomes and even more disturbing is this trend seen in women of color seeking fertility treatment.”
Similar racial disparities have emerged among mothers, too. Black women are about three times more likely to die from pregnancy-related causes than White women, according to the US Centers for Disease Control and Prevention. Multiple factors contribute to the disparities in maternal mortality, such as differences in having access to quality health care, underlying chronic conditions, structural racism and implicit bias.
In 2020, a report from the CDC found that infant death rates declined in the United States between 2000 and 2017, but Black infants still had more than twice the risk of dying as White infants.
Going forward, Lisonkova said, she hopes research expands beyond the birth of one baby to examine outcomes among twins, which are a common result of assisted reproduction.