Natalie Dayan1, K S Joseph2, Deshayne B Fell2, Carl A Laskin2, Olga Basso2, Alison L Park2, Jin Luo2, Jun Guan2, Joel G Ray2. 1. Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont. Natalie.dayan@mcgill.ca. 2. Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont.
Abstract
BACKGROUND: The extent to which infertility treatment predicts severe maternal morbidity is not well known. We examined the association between infertility treatment and severe maternal morbidity in pregnancy and the postpartum period. METHODS: We conducted a cohort study using population-based registries from Ontario between 2006 and 2012. Pregnancies achieved using infertility treatment (ovulation induction, intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection) were compared with unassisted pregnancies using propensity score matching, based on demographic, reproductive and obstetric factors. The primary outcome was a validated composite of severe maternal morbidity or maternal death from 20 weeks' gestation to 42 days postpartum. We also calculated the odds ratio of a woman having 1, 2, or 3 or more severe maternal morbidity indicators in relation to invasive (e.g., in vitro fertilization) or noninvasive (e.g., intrauterine insemination) infertility treatment. RESULTS: We matched 11 546 infertility treatment pregnancies with 47 553 untreated pregnancies. Severe maternal morbidity or maternal death occurred in 356 infertility-treated pregnancies (30.8 per 1000 deliveries) versus 1054 untreated pregnancies (22.2 per 1000 deliveries); relative risk 1.39 (95% confidence interval [CI] 1.23-1.56). The likelihood of a woman having 3 or more severe maternal morbidity indicators was increased in women who received invasive infertility treatment (odds ratio [OR] 2.28, 95% CI 1.56-3.33) but not in those who received noninvasive infertility treatment (OR 0.99, 95% CI 0.57-1.72). INTERPRETATION: Women who undergo infertility treatment, particularly in vitro fertilization, are at somewhat higher risk of severe maternal morbidity or death. Efforts are needed to identify patient- and treatment-specific predictors of severe maternal morbidity that may influence the type of treatment a woman is offered.
BACKGROUND: The extent to which infertility treatment predicts severe maternal morbidity is not well known. We examined the association between infertility treatment and severe maternal morbidity in pregnancy and the postpartum period. METHODS: We conducted a cohort study using population-based registries from Ontario between 2006 and 2012. Pregnancies achieved using infertility treatment (ovulation induction, intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection) were compared with unassisted pregnancies using propensity score matching, based on demographic, reproductive and obstetric factors. The primary outcome was a validated composite of severe maternal morbidity or maternal death from 20 weeks' gestation to 42 days postpartum. We also calculated the odds ratio of a woman having 1, 2, or 3 or more severe maternal morbidity indicators in relation to invasive (e.g., in vitro fertilization) or noninvasive (e.g., intrauterine insemination) infertility treatment. RESULTS: We matched 11 546 infertility treatment pregnancies with 47 553 untreated pregnancies. Severe maternal morbidity or maternal death occurred in 356 infertility-treated pregnancies (30.8 per 1000 deliveries) versus 1054 untreated pregnancies (22.2 per 1000 deliveries); relative risk 1.39 (95% confidence interval [CI] 1.23-1.56). The likelihood of a woman having 3 or more severe maternal morbidity indicators was increased in women who received invasive infertility treatment (odds ratio [OR] 2.28, 95% CI 1.56-3.33) but not in those who received noninvasive infertility treatment (OR 0.99, 95% CI 0.57-1.72). INTERPRETATION:Women who undergo infertility treatment, particularly in vitro fertilization, are at somewhat higher risk of severe maternal morbidity or death. Efforts are needed to identify patient- and treatment-specific predictors of severe maternal morbidity that may influence the type of treatment a woman is offered.
Authors: K S Joseph; Shiliang Liu; Jocelyn Rouleau; Russell S Kirby; Michael S Kramer; Reg Sauve; William D Fraser; David C Young; Robert M Liston Journal: J Obstet Gynaecol Can Date: 2010-09
Authors: Jan P Vandenbroucke; Erik von Elm; Douglas G Altman; Peter C Gøtzsche; Cynthia D Mulrow; Stuart J Pocock; Charles Poole; James J Schlesselman; Matthias Egger Journal: Epidemiology Date: 2007-11 Impact factor: 4.822
Authors: Jane Cleary-Goldman; Fergal D Malone; John Vidaver; Robert H Ball; David A Nyberg; Christine H Comstock; George R Saade; Keith A Eddleman; Susan Klugman; Lorraine Dugoff; Ilan E Timor-Tritsch; Sabrina D Craigo; Stephen R Carr; Honor M Wolfe; Diana W Bianchi; Mary D'Alton Journal: Obstet Gynecol Date: 2005-05 Impact factor: 7.661
Authors: Kazuyoshi Aoyama; Ruxandra Pinto; Joel G Ray; Andrea D Hill; Damon C Scales; Stephen E Lapinsky; Michelle A Hladunewich; Gareth R Seaward; Robert A Fowler Journal: JAMA Netw Open Date: 2019-08-02
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
Authors: Lisa M Korst; Kimberly D Gregory; Lisa A Nicholas; Samia Saeb; David J Reynen; Jennifer L Troyan; Naomi Greene; Moshe Fridman Journal: Matern Health Neonatol Perinatol Date: 2021-01-06
Authors: Natalie Dayan; Gabriel D Shapiro; Jin Luo; Jun Guan; Deshayne B Fell; Carl A Laskin; Olga Basso; Alison L Park; Joel G Ray Journal: BMC Pregnancy Childbirth Date: 2021-10-06 Impact factor: 3.007
Authors: Georgina M Chambers; Stephanie K Y Choi; Katie Irvine; Christos Venetis; Katie Harris; Alys Havard; Robert J Norman; Kei Lui; William Ledger; Louisa R Jorm Journal: Int J Popul Data Sci Date: 2021-09-13
Authors: Abee L Boyles; Brandiese E Beverly; Suzanne E Fenton; Chandra L Jackson; Anne Marie Z Jukic; Vicki L Sutherland; Donna D Baird; Gwen W Collman; Darlene Dixon; Kelly K Ferguson; Janet E Hall; Elizabeth M Martin; Thaddeus T Schug; Alexandra J White; Kelly J Chandler Journal: J Womens Health (Larchmt) Date: 2020-11-18 Impact factor: 2.681