Maternal and neonatal outcomes of assisted reproductive technology versus unassisted pregnancy: A propensity score-matched analysis

Abstract

Background: Assisted reproductive technology (ART) is generally safe, but still associated with risks of various adverse maternal and neonatal outcomes.Methods: This retrospective cohort study included all deliveries (through either ART or unassisted pregnancy) during a period from January 5th, 2015 to September 30th, 2020 at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. A propensity score-matched (PSM) analysis was conducted to compare adverse maternal and neonatal outcomes between ART and unassisted pregnancy. The PSM was performed at a 1:4 ratio using a caliper width that equals to 0.02 of the standard deviation of the propensity score logit. The results are presented as relative risk (RR) and 95% confidence interval (95%CI).Results: We screened a total of 78,022 deliveries: 4,310 (5.5%) through ART and the remaining 73,712 (94.5%) through unassisted pregnancy. The ART group had older age (33.2±3.9 vs 30.4±4.0 years), higher rate of cesarean section (70.2% vs 38.1%) and multiple pregnancies (23.6% vs 1.7%). In the PSM analysis (4,218 and 15,003 deliveries, respectively), the ART group had higher risks of preeclampsia (10.5% vs 5.7%, RR: 1.57, 95%CI: 1.44-1.71), gestational diabetes mellitus (19.5% vs 16.0%, RR: 1.27, 95%CI: 1.16-1.38) and placenta-related diseases, including placenta previa (2.7% vs 1.8%, RR: 1.52, 95% CI: 1.21-1.89), placenta accreta spectrum (6.8% vs 3.0%, RR: 1.95, 95%CI: 1.72-2.22) and abnormal placental morphology (8.4% vs 5.5%, RR: 1.22, 95%CI: 1.14-1.30). In singletons, the ART group had higher risks of large-for-gestational-age (LGA) (13.7% vs 10.2%, RR: 1.40, 95%CI: 1.25-1.57) and stillbirth (0.3% vs 0.1%, RR: 2.24, 95% CI: 1.25-4.03) but lower risk of small-for-gestational-age (SGA) (4.2% vs 5.4%, RR: 0.84, 95%CI: 0.73-0.97). In multiple births, the ART group had lower risks of SGA (13.4% vs 17.8%, RR:0.83, 95%CI: 0.74-0.93), preterm birth (44.8% vs 59.2%, RR: 0.56, 95%CI: 0.49-0.64) and stillbirth (0.1% vs 0.6%, RR: 0.42, 95%CI: 0.20-0.90). Analysis of the overall, pre-matching study population yielded largely similar findings.Conclusion: Pregnancy through ART was associated with higher risks of most maternal outcomes. Interestingly, the risks of neonatal outcomes differed between singleton and multiple birth groups.

Analysis of the characteristics of blood lipid metabolism in twin pregnancy

“…13 While there is an obvious need in the Southwest, the need for Spanishspeaking physicians is present throughout the country. 1 By 2005, less than half of medical schools were providing any instruction on medical Spanish. 14 A survey published last year showed that among medical schools participating in the survey, 78% offered medical Spanish.…”

“…Spanish is the most common non-English language spoken in the USA. 1 The USA also has the second largest population of Spanish speakers in the world after Mexico. 2 Native Spanish speakers experience barriers to healthcare and are known to be medically underserved.…”

“…With the development of assisted reproductive technology, the probability of twin pregnancy is getting higher and higher. 1 However, compared with singleton pregnancy, twin pregnancy is a high-risk pregnancy, and is more prone to bring about complications such as high blood pressure, high blood glucose, infection, premature rupture of membranes, premature delivery, low weight, and asphyxia, thereby causing some adverse pregnancy outcomes, and affecting the safety of mothers and fetuses. [2][3][4] Previous studies have shown that maternal blood lipid level of singleton pregnancy under normal pregnancy conditions increases, but the abnormally elevated blood lipid is closely related to the adverse pregnancy outcome.…”