Obstetric and perinatal complications associated with assisted reproductive treatment in Spain

Abstract

Background Although most newborns conceived through assisted reproductive treatments are healthy, there are concerns about the safety of reproductive techniques and their effect on foetal/maternal well-being. Objective This study aims to describe the incidence of obstetric and perinatal complications in women undergoing assisted reproductive treatments in the Spanish Health System. Method This is a cross-sectional observational study aimed at women who have been mothers between 2013 and 2018 in Spain. The data was collected through an online survey of 42 items that was distributed through lactation associations and postpartum support groups. In the data analysis, crude odds ratios (OR) and adjusted odds ratios (AOR) were calculated, through a multivariate analysis with binary logistic regression and multinomial logistic regression. Results Five thousand nine hundred forty-two women participated, 2.3% (139) through artificial insemination and 8.2% (486) through in vitro fertilisation (IVF) techniques. Women who underwent IVF had a higher likelihood of suffering problems during pregnancy (OR = 1.71; 95% confidence intervals (95% CI), 1.37-2.13), delivery (OR = 1.43; 95% CI, 1.01-2.02), and postpartum (OR = 1.94; 95% CI, 1.40-2.69) than women with spontaneous pregnancy. No increased likelihood of neonatal problems was observed in this group except for twin pregnancy (OR = 9.17; 95% CI, 6.02-13.96) and prematurity (OR = 1.43; 95% CI, 1.01-2.02). No differences were observed between spontaneous pregnancies and those achieved by artificial insemination. Conclusions Pregnancies achieved through IVF present a higher risk of complications before, during and after delivery. However, there is no increased risk of neonatal problems except for a higher likelihood of twin pregnancy and prematurity.

Perinatal and pediatric outcomes associated with the use of fertility treatment: a population-based retrospective cohort study in Ontario, Canada

“…Consistent with our findings, several studies with ART (IVF and IVF-ICSI) and/or stand-alone use of non-ART fertility treatments as distinct exposure group(s) found significantly increased risk of preterm and very preterm birth [ 42 – 49 ], cesarean delivery [ 42 ], low Apgar score [ 13 , 47 ], and composite neonatal morbidity [ 13 ]. Higher risks were observed among ART pregnancies than non-ART pregnancies [ 43 , 44 ].…”

A decennial cross-sectional review of assisted reproductive technology in a Tertiary Hospital in Southwest Nigeria

“…Dimanlig-Cruz et al in a Canadian population-based study found that crude cumulative incidences of adverse pregnancy and birth outcomes, except for small gestational age, were highest in ART pregnancies [ 26 ]. They observed, like some other European population-based studies [ 27 , 28 ], that “compared with spontaneously conceived pregnancies, ART pregnancies had significantly increased risks of stillbirth (aRR 2.26) multiple birth (aRR 8.95), cesarean delivery (aRR 1.44), preterm birth (aRR 2.06), very preterm birth (aRR 2.99), and low Apgar score (aRR 1.28)” [ 26 ]. However, a limitation of our study is that we did not compare pregnancy outcomes in ART and non-ART pregnancies during the study period, to possibly corroborate findings by Dimanlig-Cruz et al This was because many data of non-ART pregnancy outcomes during the same period were incomplete and/or missing due to their non-electronic paper documentation.…”

Restoring fertility in women aged 40 years and older after tubal ligation: tubal anastomosis versus in vitro fertilization

“…Given these data, it is unlikely that IVF in itself would confer an increased risk of congenital anomalies. Furthermore, high rates of multiple gestation following assisted reproduction have also contributed greatly to statistics regarding pregnancy morbidity, but increasing uptake of single-embryo transfer when possible will progressively reduce resulting pregnancy costs and risks (38)(39)(40).…”