The effect of IVF pregnancies on mortality and morbidity in tertiary unit

The association of adverse outcomes with pregnancy conception methods among low-risk term pregnancies

OBJECTIVE

To compare composite neonatal and maternal adverse outcomes among low-risk singleton pregnancies at 37-41 weeks among conception methods: spontaneously-conceived (SC) pregnancy; infertility medications and/or intrauterine insemination (IFM/IUI); and assisted reproductive technology (ART).

DESIGN

Population-based retrospective cohort study.

SETTING

US Vital Statistics datasets 2013-2017.

PATIENT(S)

Low-risk pregnancies (without hypertensive disorders, pregestational or gestational diabetes, or history of preterm birth) of women ≥20 years with nonanomalous singletons, who labored, delivered at 37-41 weeks, and had data on pregnancy conception method.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

The primary outcome was the composite neonatal adverse outcome (CNAO). The secondary outcome was the composite maternal adverse outcome (CMAO).

RESULT(S)

Of the 19.7 million deliveries during the study period, 54.0% (N = 10,676,184) met the inclusion criteria, with 99.0% (N = 10,573,741) being conceived spontaneously, 0.4% (N = 47,227) by IFM/IUI, and 0.5% (N = 55,216) by ART. The overall rate of CNAO was 6.68 per 1,000 live births. Compared with SC, the risk of CNAO was significantly higher among IFM/IUI (adjusted relative risk [aRR], 1.29; 95% CI, 1.18-1.41) and ART (aRR, 1.29; 95% CI, 1.18-1.39). The overall rate of CMAO was 2.50 per 1,000 live births. Compared with SC, the risk of CMAO was significantly increased among IFM/IUI (aRR, 1.72; 95% CI, 1.50-1.97) and ART (aRR, 2.40; 95% CI, 2.17-2.65).

CONCLUSION(S)

Among low-risk term singleton pregnancies, IFM/IUI and ART have modestly higher rates of adverse outcomes to maternal-neonatal dyad than SC.

Outcomes of preterm infants conceived with in vitro fertilization

OBJECTIVES

To determine if there is increased risk of prematurity-related complications for in vitro fertilization (IVF)-conceived preterm infants compared to matched controls.

STUDY DESIGN

Cohort study of 23-34 weeks' preterm infants from 329 US NICUs discharged from 2009 to 2016. Each IVF patient was matched to three controls.

RESULTS

We identified 6,756 IVF-conceived preterm infants who were matched with 20,268 controls. IVF-conceived infants had no increase in non-respiratory morbidities but had significantly higher rates of bronchopulmonary dysplasia (8.4% vs 7%, p < 0.001) and significantly greater exposure to common chronic respiratory medications.

CONCLUSIONS

In this large cohort of IVF-conceived preterm infants we found similar outcomes to controls with the exception of bronchopulmonary dysplasia and respiratory medication exposure. Further research is needed to explore the influence of in vitro fertilization on the development of neonatal respiratory disease.

Comparison of Risk Factors Related to Intraventricular Hemorrhage between Preterm Infants Born After Normal and in Vitro Fertilization Conceptions

OBJECTIVES

We aimed to compare the level of significance of risk factors related Intraventricular hemorrhage (IVH) between preterm infants born after IVF and non-IVF conceptions.

MATERIALS & METHODS

This historical cohort study was done in four Iranian Hospitals in 2013-2014. Overall, 155 preterm newborns were divided into case (IVF) and control (normal conception) groups. Both groups' demographic data were extracted and recorded. The incidence of IVH and its grades were compared between case and control groups. Significant related risk factors were also considered.

RESULTS

No differences were observed between 2 groups except for gestational age and mode of delivery. The incidence of IVH especially grades II and III were significantly higher in the case group (P=0.003). Results showed no correlations between Gestational age (GA), birth weight and number of gestations with the incidence of IVH in the case group (0.059, 0.85 and 0.49, respectively). On the other hand, among GA, birth weight and number of gestations; multi gestations (P=0.0001) was an effective risk factor for IVH occurrence in the controls.

CONCLUSION

The incidence of IVH in the IVF group was significantly higher than in the non-IVF group. IVF as an independent risk factor may cause high-grade IVH; however, in the controls, multi gestational pregnancy (P=0.0001) was an effective risk factor for IVH occurrence.

Is artificial reproductive technology a risk factor for retinopathy of prematurity independent of the generation of multiple births?

PURPOSE

There is some debate regarding whether artificial reproductive technology (ART) constitutes an independent risk factor for retinopathy of prematurity (ROP). We wanted to assess the prevalence of ART in multiple birth infants seen for ROP screening and whether or not ROP was identified or treated, in order to evaluate whether ART contributes a risk factor for ROP independent of the generation of multiple births.

METHODS

A retrospective audit was performed of all multiple birth babies admitted to a tertiary neonatal unit who met the UK ROP screening criteria (<32 weeks gestational age [GA] and/or <1,501 g birthweight [BW]).

RESULTS

A total of 205 babies met our criteria, of whom 87.3% were twins. A total of 39.5% were born following ART. A total of 30.5% of the non-ART group developed ROP vs 34% of the ART group (p = 0.837). Stage 3 ROP developed in 5.1% of non-ART babies and 6% of ART babies. A total of 8.5% of non-ART babies and 10% of ART babies required treatment for ROP. Logistic regression demonstrated that ART was not independently associated with development of ROP.

CONCLUSIONS

Artificial reproductive technology multiple birth babies make up a considerable proportion of the ROP screening burden and their number is likely to increase as ART is increasingly available and utilized. We found no significant difference between the numbers of babies developing ROP in the ART vs non-ART groups, but the numbers are small. The estimated odds of developing ROP are slightly higher in the ART babies, so our data do not rule out a possible association.

Impact of risk factors other than prematurity on periventricular leukomalacia. A population-based matched case control study

OBJECTIVE

Periventricular leukomalacia (PVL) is a neonatal brain white matter injury associated with development of cerebral palsy, intellectual impairment, and visual disturbances. PVL is more common in premature neonates. Our objective was to examine the impact of several potential risk factors other than prematurity on the incidence of PVL.

STUDY DESIGN

A case-control study based on the Slovenian National Perinatal Information System data for the period 2002-2011. All singleton and twin pregnancies delivered at ≥22 weeks' in Slovenia during the study period were included. Cases were pregnancies with PVL in at least one neonate. For each pregnancy in the case cohort, three pregnancies matched by gestational age and plurality were selected. Chi-square test was used to examine the associations between PVL and several potential risk factors: maternal age, pre-pregnancy body-mass-index, preexisting diabetes, gestational diabetes, pregnancy after in-vitro-fertilization, severe preeclampsia, vaginal delivery, no steroid therapy prior to delivery, small for gestational age, and fetal-inflammatory-response-syndrome. P<0.05 was considered statistically significant.

RESULTS

One lakh ninety one thousand and eighty three singleton and 3377 twin pregnancies delivered at ≥22 weeks' in Slovenia during the study period. PVL was diagnosed in 86 singletons (0.045%) and 25 twins (0.74%). In all twin pregnancy cases only one twin was diagnosed with PVL. 258 singleton and 75 twin controls were matched to the 86 singleton and 25 twin cases. Of all risk factors studied, only maternal obesity and chorioamnionitis were significantly associated with PVL.

CONCLUSION

Maternal obesity and chorioamnionitis increase the risk of PVL beyond that expected solely from prematurity.

Maternal race, demography, and health care disparities impact risk for intraventricular hemorrhage in preterm neonates

OBJECTIVE

To determine whether risk factors associated with grade 2-4 intraventricular hemorrhage (IVH) differs between infants of African ancestry and white infants.

STUDY DESIGN

Inborn, appropriate for gestational age infants with birth weight 500-1250 g and exposure to at least 1 dose of antenatal steroids were enrolled in 24 neonatal intensive care units. Cases had grade 2-4 IVH and controls matched for site, race, and birth weight range had 2 normal ultrasounds read centrally. Multivariate logistic regression modeling identified factors associated with IVH across African ancestry and white race.

RESULTS

Subjects included 579 African ancestry or white race infants with grade 2-4 IVH and 532 controls. Mothers of African ancestry children were less educated, and white case mothers were more likely to have more than 1 prenatal visit and multiple gestation (P ≤ .01 for all). Increasing gestational age (P = .01), preeclampsia (P < .001), complete antenatal steroid exposure (P = .02), cesarean delivery (P < .001), and white race (P = .01) were associated with decreased risk for IVH. Chorioamnionitis (P = .01), 5-minute Apgar score <3 (P < .004), surfactant use (P < .001), and high-frequency ventilation (P < .001) were associated with increased risk for IVH. Among African ancestry infants, having more than 1 prenatal visit was associated with decreased risk (P = .02). Among white infants, multiple gestation was associated with increased risk (P < .001), and higher maternal education was associated with decreased risk (P < .05).

CONCLUSION

The risk for IVH differs between infants of African ancestry and white infants, possibly attributable to both race and health care disparities.