Adverse pregnancy and birth outcomes associated with underlying diagnosis with and without assisted reproductive technology treatment

Abstract

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.

Pregnancy, birth, and infant outcomes by maternal fertility status: the Massachusetts Outcomes Study of Assisted Reproductive Technology

“…Endometriosis is associated with increased risks of antepartum bleeding and placental complications, irrespective of IVF treatment (31, 64). Our prior analyses of IVF pregnancies indicated that among all infertility diagnoses, endometriosis had the highest rates of uterine bleeding (4.8%) and placenta previa (2.4%) (34).…”

Maternal and neonatal outcomes in women with colorectal endometriosis

“…During the study period, 72 pregnancies from 67 women with colorectal endometriosis were recorded ( Table 1). The median age (range) of the women was 31 (23-43) years and median body mass index (BMI) (range) was 21.7 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) kg/m 2 . Forty-four of the 67 (66%) women had a documented infertility.…”

“…The median delivery gestational age (range) was 39 (33)(34)(35)(36)(37)(38)(39)(40)(41)(42) weeks. There were 70 singleton pregnancies and two twin pregnancies (Tables 2 and 3).…”

Vitrified-warmed single-embryo transfers may be associated with increased maternal complications compared with fresh single-embryo transfers

“…However, recent reviews and meta-analysis have shown that singletons conceived by IVF are prone to higher rates of adverse pregnancy outcomes including low birthweight (LBW), preterm deliveries (PTL) and congenital malformation compared with spontaneously conceived singletons (Hansen et al, 2013;Henningsen et al, 2011;Schieve et al, 2002;Wang et al, 2005). Whether this adverse outcome is related to the IVF treatment or to the underlying subfertility itself is unclear (Jaques et al, 2010;Stern et al, 2015;Zhu et al, 2006).…”