Objective
To compare the risks for adverse pregnancy and birth outcomes by diagnoses with and without ART treatment to non-ART pregnancies in fertile women.
Design
Historical cohort
Setting
Massachusetts vital records linked to ART clinic data from SART CORS
Patients
Diagnoses included male factor (ART only), endometriosis, ovulation disorders, tubal (ART only) and reproductive inflammatory disorders (non-ART only). Pregnancies resulting in singleton and twin live births from 2004–08 were linked to hospital discharges in women who had ART treatment (N=3,689), women with no ART treatment in the current pregnancy (N=4,098) and non-ART pregnancies to fertile women (N= 297,987).
Interventions
None
Main Outcome Measures
Risks of gestational diabetes, prenatal hospitalizations, prematurity, low birth weight, and small-for-gestation were modeled using multivariate logistic regression with fertile deliveries as the reference group adjusted for maternal age, race/ethnicity, education, chronic hypertension, diabetes mellitus, and plurality (adjusted odds ratios, AORs, and 95% confidence intervals, CI).
Results
Risk of prenatal hospital admissions was increased for endometriosis (ART 1.97, 1.38–2.80; non-ART 3.34, 2.59–4.31), ovulation disorders (ART 2.31, 1.81–2.96; non-ART 2.56, 2.05–3.21), tubal (ART 1.51, 1.14–2.01), and reproductive inflammation (non-ART 2.79, 2.47–3.15). Gestational diabetes was increased for women with ovulation disorders (ART 2.17, 1.72–2.73; non-ART 1.94, 1.52–2.48). Preterm delivery (AORs 1.24–1.93) and low birthweight (AORs 1.27–1.60) were increased in all groups except endometriosis with ART.
Conclusions
The findings indicate substantial excess perinatal morbidities associated with underlying infertility-related diagnoses in both ART-treated and non-ART-treated women.
