Sabine Ensing1, Ameen Abu-Hanna2, Tessa J Roseboom3, Sjoerd Repping4, Fulco van der Veen4, Ben Willem J Mol5, Anita C J Ravelli2. 1. Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands; Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: s.ensing@amc.uva.nl. 2. Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands. 3. Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands. 4. Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands. 5. Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands; School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia.
Abstract
OBJECTIVE: To study risk of birth asphyxia and related morbidity among term singletons born after medically assisted reproduction (MAR). DESIGN: Population cohort study. SETTING: Not applicable. PATIENT(S): A total of 1,953,932 term singleton pregnancies selected from a national registry for 1999-2011. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Primary outcome Apgar score <4; secondary outcomes Apgar score <7, intrauterine fetal death, perinatal mortality, congenital anomalies, small for gestational age, asphyxia related morbidity, and cesarean delivery. RESULT(S): The risks of birth asphyxia and related morbidity were calculated in women who conceived either through MAR or spontaneously (SC), with a subgroup analysis for in vitro fertilization (IVF). An additional propensity score matching analysis was performed with matching on multiple maternal baseline covariates (maternal age, ethnicity, socioeconomic status, parity, year of birth, and preexistent diseases). Each MAR pregnancy was matched to three SC controls. Relative to SC, the MAR singletons had an increased risk of adverse neonatal outcomes including Apgar score <4 (adjusted odds ratio [OR] 1.29; 95% CI, 1.14-1.46) and intrauterine fetal death (adjusted OR 1.61; 95% CI, 1.35-1.91). After propensity score matching, the risk of an Apgar score <4 was comparable between MAR and SC singletons (OR 0.99; 95% CI, 0.87-1.14). Cesarean delivery for both fetal distress and nonprogressive labor occurred more among MAR pregnancies compared with SC pregnancies. CONCLUSION(S): Term singletons conceived after MAR have an increased risk of morbidity related to birth asphyxia. Because this is mainly due to maternal characteristics, obstetric caregivers should be aware that the increased rates of cesareans reflect the behavior of women and physicians rather than increased perinatal complications.
OBJECTIVE: To study risk of birth asphyxia and related morbidity among term singletons born after medically assisted reproduction (MAR). DESIGN: Population cohort study. SETTING: Not applicable. PATIENT(S): A total of 1,953,932 term singleton pregnancies selected from a national registry for 1999-2011. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Primary outcome Apgar score <4; secondary outcomes Apgar score <7, intrauterine fetal death, perinatal mortality, congenital anomalies, small for gestational age, asphyxia related morbidity, and cesarean delivery. RESULT(S): The risks of birth asphyxia and related morbidity were calculated in women who conceived either through MAR or spontaneously (SC), with a subgroup analysis for in vitro fertilization (IVF). An additional propensity score matching analysis was performed with matching on multiple maternal baseline covariates (maternal age, ethnicity, socioeconomic status, parity, year of birth, and preexistent diseases). Each MAR pregnancy was matched to three SC controls. Relative to SC, the MAR singletons had an increased risk of adverse neonatal outcomes including Apgar score <4 (adjusted odds ratio [OR] 1.29; 95% CI, 1.14-1.46) and intrauterine fetal death (adjusted OR 1.61; 95% CI, 1.35-1.91). After propensity score matching, the risk of an Apgar score <4 was comparable between MAR and SC singletons (OR 0.99; 95% CI, 0.87-1.14). Cesarean delivery for both fetal distress and nonprogressive labor occurred more among MAR pregnancies compared with SC pregnancies. CONCLUSION(S): Term singletons conceived after MAR have an increased risk of morbidity related to birth asphyxia. Because this is mainly due to maternal characteristics, obstetric caregivers should be aware that the increased rates of cesareans reflect the behavior of women and physicians rather than increased perinatal complications.
Authors: Nakeisha A Lodge-Tulloch; Flavia T S Elias; Jessica Pudwell; Laura Gaudet; Mark Walker; Graeme N Smith; Maria P Velez Journal: BMC Pregnancy Childbirth Date: 2021-03-22 Impact factor: 3.007