This study aims to investigate the factors inducing premature birth among women undergoing assisted reproductive technology (ART) treatments.

The data of 369 pregnant patients who underwent ART delivered at the Department of Obstetrics and Gynaecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, from Jan. 2022 to Dec. 2023 were selected in the study. Patients were divided into two groups: premature birth group (n=189) and term delivery group (n=180). General data, ART-related materials, pregnancy complications, comorbidities, and neonatal status were examined in both groups. Differences between the groups were assessed using t-tests and chi-square tests. The logistic regression was utilized to identify independent risk factors for premature birth.

There were statistically significant differences in the rate of twin pregnancies (40.7% vs 3.9%, χ²=71.212), pre-pregnancy body mass index [(22.78±3.71) kg/m² vs (21.62±3.12) kg/m^2, t=-2.952], primary infertility (63.8% vs 35.9%, χ²=21.069), in vitro fertilization (62.1% vs 42.2%, χ²=10.491), numbers of retrieved oocytes [(13.94±8.72) vs (13.54±7.28), t=-0.402], estradiol (E₂) levels at the day of human chorionic gonadotropin (HCG) administration [(2906.5±1892.0) pg/ml vs (2598.18±1456.5) pg/ml, t=-1.493], premature rupture of membranes (9.5% vs 0, χ²=18.022), hypertensive disorders of pregnancy (16.9% vs 6.1%, χ²=10.484), cervical insufficiency (6.3% vs 0.6%, χ²=9.105), and ovary-related disorders (6.3% vs 1.7%, χ²=5.184) in the premature birth group and term delivery group (P<0.05). The multivariate logistic regressive analysis showed that the risks of premature birth of pregnant women with twin pregnancies (OR=25.637, 95%CI: 8.782~74.844, P<0.001) and hypertensive disorders of pregnancy (OR=2.809, 95%CI: 1.149~6.865, P<0.05) were significantly increased.

Twin pregnancies, overweight and obesity in pre-pregnancy, history of primary infertility, application of in vitro fertilization, increased numbers of retrieved oocytes, elevated E₂ levels at the day of HCG administration, hypertensive disorders of pregnancy, premature rupture of membranes, cervical insufficiency, and ovary-related disorders are all the influenced factors of premature birth with ART. Hypertensive disorders of pregnancy and twin pregnancies are the factors independently affecting the premature birth.