Socioeconomic status affects the prevalence, but not the perinatal outcomes, of in vitro fertilization pregnancies

Räisänen, Sari; Randell, Kaisa; Nielsen, Henriette Svarre; Gissler, Mika; Kramer, Michael R.; Klemetti, Reija; Heinonen, Seppo

doi:10.1093/humrep/det307

Cited by 46 publications

(44 citation statements)

References 21 publications

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“…Furthermore, it might be speculated that a part of SES disparity in giving birth by CS might be explained by differences in delivery training. The results of the present study contradicted those obtained in previous studies, which indicated inequity in both the access to healthcare and healthcare services offered, with a positive social gradient in IVF services [21] and cardiac procedures [19,20] in Finland.…”

Section: Discussioncontrasting

confidence: 99%

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Influence of delivery characteristics and socioeconomic status on giving birth by caesarean section – a cross sectional study during 2000–2010 in Finland

Räisänen

Gissler

Kramer

et al. 2014

BMC Pregnancy Childbirth

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BackgroundCaesarean section (CS) rates especially without medical indication are rising worldwide. Most of indications for CS are relative and CS rates for various indications vary widely. There is an increasing tendency to perform CSs without medical indication on maternal request. Women with higher socioeconomic status (SES) are more likely to give birth by CS. We aimed to study whether giving birth by CS was associated with SES and other characteristics among singleton births during 2000–2010 in Finland with publicly funded health care.MethodsData were gathered from the Finnish Medical Birth Register. The likelihood of giving birth by CS according to CS type (planned and non-planned), parity (nulliparous vs. multiparous), socio-demographic factors, delivery characteristics and time periods (2000–2003, 2004–2007 and 2008–2010) was determined by using logistic regression analysis. SES was classified as upper white collar workers (highest SES), lower white collar workers, blue collar workers (lowest SES), others (all unclassifiable cases) and cases with missing information.ResultsIn total, 19.8% (51,511 of 259,736) of the nulliparous women and 13.1% (47,271 of 360,727) of the multiparous women gave birth by CS. CS was associated with several delivery characteristics, such as placental abruption, placenta previa, birth weight and fear of childbirth, among both parity groups. After adjustment, the likelihood of giving birth by planned CS was reduced by 40% in nulliparous and 55% in multiparous women from 2000–2003 to 2008–2010, whereas the likelihood of non-planned CSs did not change. Giving birth by planned and non-planned CS was up to 9% higher in nulliparous women and up to 17% higher in multiparous women in the lowest SES groups compared to the highest SES group.ConclusionsGiving birth by CS varied by clinical indications. Women with the lowest SES were more likely to give birth by CS, indicating that the known social disparity in pregnancy complications increases the need for operative deliveries in these women. Overall, the CS policy in Finland shows favoring a trial of labor over planned CS and reflects no inequity in healthcare services.

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Section: Discussioncontrasting

confidence: 99%

“…Further, women with the highest SES were more likely to undergo in vitro fertilization in Finland [21-23]. In Finland, practically all pregnant women give birth in public hospitals with free-access, and private delivery care services are not provided.…”

Section: Introductionmentioning

confidence: 99%

Influence of delivery characteristics and socioeconomic status on giving birth by caesarean section – a cross sectional study during 2000–2010 in Finland

Räisänen

Gissler

Kramer

et al. 2014

BMC Pregnancy Childbirth

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“…This could be because nulliparous women with placenta previa were less likely to be smokers in our study, and no significant association was noted in multiparous women. Many nulliparous women conceived by IVF and were ofhigh SES, older and less likely to smoke (18). …”

Section: Discussionmentioning

confidence: 99%

Placenta Previa and the Risk of Delivering a Small-for-Gestational-Age Newborn

Räisänen

Kancherla

Kramer

et al. 2014

Obstetrics &Amp; Gynecology

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Objective To evaluate whether there is an association between placenta previa and delivery of a small-for-gestational-age (SGA) newborn and to quantify the contribution of individual risk factors for SGA that are associated with placenta previa, stratified by maternal parity. Methods A cross sectional study utilizing the Finnish Medical Birth Register during 2000–2010. All singleton births (N=596,562) were included; major congenital anomalies were excluded. An association between SGA (< 2 standard deviations below the mean) and placenta previa was modeled by parity-specific unadjusted and adjusted statistical models. Results Placenta previa complicated 625 of 249,476 singleton births among nulliparous women (2.50/1,000) and (915 of 347,086 singleton births among multiparous women (2.64/1,000). Among nulliparous women, the most common risk factor for placenta previa was in vitro fertilization (IVF); placenta previa was not associated with an increased prevalence of SGA, controlling for maternal age, smoking, IVF, socioeconomic status, and preeclampsia (aOR=0.81; 95% CI=0.57–1.17). Among multiparous women, placenta previa was associated with a two-fold increased risk of SGA, controlling for maternal age, parity, prior preterm birth, prior caesarean delivery, prior SGA newborn, prior preeclampsia, smoking, IVF, socioeconomic status, and preeclampsia (aOR=2.08; 95% CI=1.50–2.89). Further, only one fourth of the association between SGA and placenta previa could be explained by controlling for risk factors clustering with placenta previa among multiparous women. Conclusions Placenta previa is associated with impaired fetal growth in multiparous but not nulliparous women.

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“…Here, it is speculated that women with gestational diabetes be advised to control their weight gain by their care providers during prenatal care. Conversely, women who conceive using ART tend to be of higher socioeconomic status and are more invested in their pregnancy . As a result, they could have monitored their weight gain more closely and have made necessary adjustment to better maintain their weight gain compared with women who conceived naturally.…”

Section: Discussionmentioning

confidence: 99%

The association between weight gain during pregnancy and intertwin delivery weight discordance using 2011–2015 birth registration data from the USA

Xiao

Shen

et al. 2018

Intl J Gynecology & Obste

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Socioeconomic status affects the prevalence, but not the perinatal outcomes, of in vitro fertilization pregnancies

Abstract: None of the authors received any funding specifically for this study, and we have no competing interests.

Cited by 46 publications

References 21 publications

Influence of delivery characteristics and socioeconomic status on giving birth by caesarean section – a cross sectional study during 2000–2010 in Finland

Influence of delivery characteristics and socioeconomic status on giving birth by caesarean section – a cross sectional study during 2000–2010 in Finland

Placenta Previa and the Risk of Delivering a Small-for-Gestational-Age Newborn

The association between weight gain during pregnancy and intertwin delivery weight discordance using 2011–2015 birth registration data from the USA

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