Trends in Severe Maternal Morbidity After Assisted Reproductive Technology in the United States, 2008–2012

Martin, Angela; Monsour, Michael; Kissin, Dmitry M.; Jamieson, Denise J.; Callaghan, William M.; Boulet, Sheree L.

doi:10.1097/aog.0000000000001197

Cited by 84 publications

(58 citation statements)

References 13 publications

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“…al. reported an SMM rate of 399 cases per 10,000 singleton deliveries between 2008–2012 (17), which is more than twice the previously reported numbers for SMM cases cased on the same diagnostic criteria (158 cases per 10,000 hospitalization deliveries in 2008–2009) (1). Our study utilizes the gold standard to identify true SMM cases based on extensive chart review, which demonstrated that only 39% of cases that screened positive were true SMM cases (69/175).…”

Section: Discussionmentioning

confidence: 78%

“…al. which demonstrated that singleton pregnancies conceived by ART were at an increased risk for SMM between 2008–2012 (17). Martin et.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have linked in vitro fertilization (IVF) with adverse obstetric outcomes such as placenta previa (13, 14), placenta abruption (13), and pre-eclampsia (13, 15, 16). To date, there are two recent studies that examined whether these associations translate into increased SMM, which concluded that singleton pregnancies conceived with assisted reproductive technology (ART) had a twofold increased risk of SMM (17, 18). However, both of these studies utilized only CDC ICD-9 codes to identify SMM cases, which have a low positive predictive value of 0.44 when validated with medical record review (7).…”

Section: Introductionmentioning

confidence: 99%

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Impact of fertility treatment on severe maternal morbidity

Wang

Ozimek

Greene

et al. 2016

Fertility and Sterility

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Objective To determine if fertility treatment is associated with increased risk of severe maternal morbidity (SMM) compared to spontaneous pregnancies. Design Retrospective cohort study Setting Single academic medical center Patients In 2012, 6543 women delivered live births >20 weeks gestation at our center. Women were categorized based on mode of conception: in vitro fertilization (IVF), non-IVF fertility treatment (NIFT), or spontaneous pregnancies. Interventions None Outcome Measure The main outcome was presence of true SMM, such as eclampsia, respiratory failure, and peripartum hysterectomy. Deliveries were screened using 1) ICD-9 codes, 2) prolonged postpartum stay, 3) maternal ICU admissions, and 4) blood transfusion. The charts of women meeting the screening criteria were reviewed to identify true SMM based on a previously validated method, recognizing that medical record review is the gold standard. Results Of the 6543 deliveries, 246 (3.8%) were IVF conceptions and 109 (1.7%) NIFT conceptions. Sixty nine (1.1%) cases of true SMM were identified. In multivariate analyses, any fertility treatment (IVF + NIFT) was associated with increased risk of SMM compared to spontaneous conceptions (OR 2.40, 95%CI 1.10–5.23). In a subset analysis of singletons only, the association between any fertility treatment (IVF + NIFT) and SMM was not statistically significant (OR 2.11, 95% CI 0.83–5.37, P=0.12). Conclusions Overall, fertility treatment increased risk for SMM events. Given the limited sample size, the negative finding with singleton gestations is inconclusive. Larger multi-center studies with accurate documentation of fertility treatment and SMM cases are needed to further clarify the risk associated with singletons.

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Section: Discussionmentioning

confidence: 78%

“…al. which demonstrated that singleton pregnancies conceived by ART were at an increased risk for SMM between 2008–2012 (17). Martin et.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of fertility treatment on severe maternal morbidity

Wang

Ozimek

Greene

et al. 2016

Fertility and Sterility

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“…Ovulation induction has also been reported to be associated with an increase in placental abruption (48). Subfertile and IVF-treated women also have greater risks of severe maternal morbidity, particularly bleeding requiring blood transfusions (36, 58–60). Factors resulting in suboptimal endometrial function may also play an important role in the risk for antepartum bleeding and abnormal placentation (61).…”

Section: Discussionmentioning

confidence: 99%

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

Luke

Gopal

Cabral

et al. 2017

American Journal of Obstetrics and Gynecology

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Background Births to subfertile women, with and without infertility treatment, have been reported to have lower birthweights and shorter gestations, even when limited to singletons. It is unknown whether these decrements are due to parental characteristics or aspects of infertility treatment. Objective To evaluate the effect of maternal fertility status on the risk of pregnancy, birth, and infant complications. Study Design All singleton live births of ≥22 weeks’ gestation and ≥350 grams birthweight to Massachusetts resident women in 2004–10 were linked to hospital discharge and vital records. Women were categorized by their fertility status as in vitro fertilization (IVF), subfertile, or fertile. Women whose births linked to IVF cycles from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System were classified as IVF. Women with indicators of subfertility but not treated with IVF were classified as subfertile. Women without indicators of subfertility or IVF treatment were classified as fertile. Risks of fifteen adverse outcomes (gestational diabetes, pregnancy hypertension, antenatal bleeding, placental complications (placenta abruptio and placenta previa), prenatal hospitalizations, primary cesarean, very low birthweight (<1,500g), low birthweight (<2,500g), small-for-gestation birthweight (Z-score ≤−1.28), large-for-gestation birthweight (Z-score ≥1.28), very preterm (<32 weeks), preterm (<37 weeks), birth defects, neonatal death (0–27 days), and infant death (0–364 days of life) were modeled by fertility status with the fertile group as reference, and the subfertile group as reference, using multivariate log binomial regression and reported as adjusted risk ratios (ARRs) and 95% confidence intervals. Results The study population included 459,623 women (441,420 fertile, 8,054 subfertile, and 10,149 IVF). Women in the subfertile and IVF groups were older than their fertile counterparts. Risks for six out of six pregnancy outcomes and six out of nine infant outcomes were increased for the subfertile group, and five out of six pregnancy outcomes and seven out of nine infant outcomes were increased for the IVF group. For four of the six pregnancy outcomes (uterine bleeding, placental complications, prenatal hospitalizations, and primary cesarean) and two of the infant outcomes (low birthweight and preterm) the risk was greater in the IVF group, with non-overlapping confidence intervals to the subfertile group, indicating a substantially higher risk among IVF-treated women. The highest risks for the IVF women were uterine bleeding (ARR 3.80, 95% CI 3.31, 4.36) and placental complications (ARR 2.81, 95% CI 2.57, 3.08), and for IVF infants, very preterm birth (ARR 2.13, 95% CI 1.80, 2.52) and very low birthweight (ARR 2.15, 95% CI 1.80, 2.56). With subfertile women as reference, risks for the IVF group were significantly increased for uterine bleeding, placental complications, prenatal hospitalizations, primary cesarean, low and very low birthweight, and preterm and very preterm bir...

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“…Improvements in medical care have led to reductions in deaths among women of reproductive age, while these medical advances and others, such as assisted reproduction, have increased the fecundity of women with chronic disease. The combination of chronic disease and pregnancy may have resulted in an increase in severe maternal morbidity 22 and death, although such a phenomenon cannot explain the two- to three-fold increase in maternal mortality ratios between 1993 and 2014. The large 23-fold increase in deaths due to other specified pregnancy-related conditions (O26.8; primarily deaths due to renal causes) between 1999 and 2014 illustrates this point.…”

Section: Discussionmentioning

confidence: 99%

Factors Underlying the Temporal Increase in Maternal Mortality in the United States

Joseph

Lisonkova

Muraca

et al. 2017

Obstetrics &Amp; Gynecology

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OBJECTIVE To identify the factors underlying the recent increase in maternal mortality ratios (maternal deaths per 100,000 live births) in the United States. METHODS We carried out a retrospective study with data on maternal deaths and live births in the United States from 1993 to 2014 obtained from the birth and death files of the Centers for Disease Control and Prevention. Underlying causes of death were examined between 1999 and 2014 using International Classification of Diseases, Tenth Revision (ICD-10) codes. Poisson regression was used to estimate maternal mortality rate ratios (RR) and 95% confidence intervals (CI) after adjusting for the introduction of a separate pregnancy question and the standard pregnancy checkbox on death certificates, and adoption of ICD-10. RESULTS Maternal mortality ratios increased from 7.55 in 1993, to 9.88 in 1999 and to 21.5 per 100,000 live births in 2014 (RR 2014 vs 1993 2.84, 95% CI 2.49 to 3.24; RR 2014 vs 1999 2.17, 95% CI 1.93 to 2.45). The increase in maternal deaths from 1999 to 2014 was mainly due to increases in maternal deaths associated with two new ICD-10 codes (O26.8 i.e., primarily renal disease and O99 i.e., other maternal diseases classifiable elsewhere); exclusion of such deaths abolished the increase in mortality (RR 1.09, 95% CI 0.94 to 1.27). Regression adjustment for improvements in surveillance also abolished the temporal increase in maternal mortality ratios (adjusted maternal mortality ratios 7.55 in 1993, 8.00 per 100,000 live births in 2013; adjusted RR 2013 vs 1993 1.06, 95% CI 0.90 to 1.25). CONCLUSION Recent increases in maternal mortality ratios in the United States are likely an artifact of improvements in surveillance and highlight past underestimation of maternal death. Complete ascertainment of maternal death in populations remains a challenge even in countries with good systems for civil registration and vital statistics.

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Trends in Severe Maternal Morbidity After Assisted Reproductive Technology in the United States, 2008–2012

Abstract: Singleton pregnancies conceived with ART are at increased risk for severe maternal morbidity; however, the rate has been decreasing since 2008. Multiple gestations have increased risk regardless of ART status.

Cited by 84 publications

References 13 publications

Impact of fertility treatment on severe maternal morbidity

Impact of fertility treatment on severe maternal morbidity

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

Factors Underlying the Temporal Increase in Maternal Mortality in the United States

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