Maternal and Live-birth Outcomes of Pregnancies following Assisted Reproductive Technology: A Retrospective Cohort Study

Abstract

This study was carried out to explore associations between assisted reproductive technology (ART) and maternal and neonatal outcomes compared with similar outcomes following spontaneously conceived births. We conducted a retrospective cohort study of pregnancies conceived by ART (N = 2641) during 2006–2014 compared to naturally conceived pregnancies (N = 5282) after matching for maternal age and birth year. Pregnancy complications, perinatal complications and neonatal outcomes of enrolled subjects were investigated and analysed by multivariate logistic regression. We found that pregnancies conceived by in vitro fertilization (IVF) were associated with a significantly increased incidence of gestational diabetes mellitus, gestational hypertension, preeclampsia, intrahepatic cholestasis of pregnancy, placenta previa, placental abruption, preterm premature rupture of membranes, placental adherence, postpartum haemorrhage, polyhydramnios, preterm labour, low birth weight, and small-for-date infant compared with spontaneously conceived births. Pregnancies conceived by intracytoplasmic sperm injection (ICSI) showed similar elevated complications, except some of the difference narrowed or disappeared. Singleton pregnancies or nulliparous pregnancies following ART still exhibited increased maternal and neonatal complications. Therefore, we conclude that pregnancies conceived following ART are at increased risks of antenatal complications, perinatal complications and poor neonatal outcomes, which may result from not only a higher incidence of multiple pregnancy, but also the manipulation involved in ART processes.

In Vitro fertilization and adverse obstetric and perinatal outcomes

“…33 A subsequent retrospective cohort study consisting 2641 IVF/ICSI-conceptions and 5282 unassisted conceptions between 2006 and 2014 showed that, among singleton IVF/ICSI conceptions, the odds of having gestational hypertension was 1.99 (95% CI 1.56 – 2.53, p<0.001) compared to singleton unassisted conceptions. 34 Singleton IVF/ICSI conceptions also showed a trend toward increased odds of having preeclampsia of 1.71 (95% CI 1.42 – 2.19, p=0.21), but this was not statistically significant. There was no significant difference in incidence of hypertensive disorders of pregnancy between IVF/ICSI twin pregnancies and twins conceived without medical assistance.…”

“…36 In another retrospective cohort study that did not control for the above confounders, Zhu and colleagues found that GDM was increased in IVF/ICSI singleton pregnancies relative to unassisted singleton pregnancies with odds ratio (OR) in IVF/ICSI singleton pregnancies 2.23 (95% CI 1.85 – 2.69). 34 A meta-analysis analyzing six cohort studies and 13,399 IVF/ICSI patients also showed a relative risk of GDM of 1.48 (95% CI 1.33 – 1.66). 33 This data suggests an increased incidence of GDM in the ART population in singleton pregnancies.…”

“…There was no significant difference in incidence of hypertensive disorders of pregnancy between IVF/ICSI twin pregnancies and twins conceived without medical assistance. 34 The similarity in the rate of hypertensive disorders in twin IVF/ICSI and unassisted pregnancies is likely because twin pregnancies, regardless of mode of conception, are at higher risk for these disorders. The association between hypertensive disorders of pregnancy in IVF is difficult to ascertain given that women pursuing IVF may be older and may have other comorbidities such as polycystic ovary syndrome (PCOS), which may have prompted infertility treatment.…”

Are singleton pregnancies after assisted reproduction technology (ART) associated with a higher risk of placental anomalies compared with non‐ART singleton pregnancies? A systematic review and meta‐analysis

“…In the last 2 years there have been a substantial number of published studies that evaluate the association of placental anomalies with ART pregnancies . Considering the marked increase in published data, a systematic appraisal of the available evidence was considered essential in order to confidently evaluate this proposed higher risk of placental anomalies after ART.…”

Children Conceived by Assisted Reproductive Technology Prone to Low Birth Weight, Preterm Birth, and Birth Defects: A Cohort Review of More Than 50,000 Live Births During 2011–2017 in Taiwan

“…Studies have revealed that ART increased the risks of preterm birth, low birth weight, congenital anomalies, and perinatal mortality as compared to that of natural pregnancies (2)(3)(4)(5)(6). The occurrences of preterm birth and low birth weight were still high in singleton births by ART (7). An increased incidence of preterm birth has been reported (8), and the risk could not be reduced even by elective single embryo transfer (9).…”