Obstetric consequences of subfertility: a retrospective cohort study

BJOG. 2016 Jul;123(8):1320-8. doi: 10.1111/1471-0528.13584. Epub 2015 Sep 2.

Abstract

Objective: To compare the risk of adverse pregnancy outcomes in women with and without subfertility and to investigate whether fertility treatment contributes to the adverse outcomes.

Design: Register-based retrospective cohort study.

Setting: Aberdeen, Scotland

Population: The exposed group included women with subfertility attending Aberdeen Fertility Clinic between 1989 and 2008 and delivering a singleton (n = 3188) or twin (n = 350) at Aberdeen Maternity Hospital between 1992 and 2009. The unexposed cohort included the remainder of women (singleton n = 52443, twin n = 1125) delivering at Aberdeen Maternity Hospital between 1992 and 2009.

Methods: The Aberdeen Fertility Centre database and Aberdeen Maternity and Neonatal Databank were linked using Community Health Index numbers. Regression models were used to calculate risk ratios and 95% confidence intervals adjusting for potential confounders.

Main outcome measures: Maternal outcomes including pre-eclampsia, antepartum haemorrhage, preterm birth, induction of labour; delivery outcomes including operative vaginal delivery, caesarean section; and offspring outcomes including low birthweight, stillbirth and neonatal death.

Results: Women with a history of subfertility who delivered a singleton were at a higher risk of pre-eclampsia [adjusted risk ratios (aRR) 1.18, 95% confidence intervals (CI) 1.02-1.37], antepartum haemorrhage (aRR 1.32, 95% CI 1.18-1.47), induction of labour (aRR 1.21, 95% CI 1.11-1.31) and very preterm delivery (<32 weeks) (aRR 1.96, 95% CI 1.53-2.49). Subfertile women delivering twins were at a higher risk of being delivered by emergency caesarean section (aRR 2.14, 95% CI 1.26-3.66). There were no significant differences in adverse outcomes for singleton pregnancies between the treated and untreated subfertile couples.

Conclusion: Subfertility per se, rather than fertility treatment, was associated with increased risk of adverse outcomes in singleton pregnancies.

Tweetable abstract: Large cohort study found higher incidence of adverse outcome in subfertile women having singletons or twins.

Keywords: Cohort study; obstetric outcomes; pregnancy complications; subfertility.

Publication types

  • Video-Audio Media

MeSH terms

  • Adult
  • Case-Control Studies
  • Cesarean Section / statistics & numerical data
  • Cohort Studies
  • Delivery, Obstetric
  • Female
  • Humans
  • Incidence
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Infertility, Female / epidemiology*
  • Information Storage and Retrieval
  • Labor, Induced / statistics & numerical data
  • Multivariate Analysis
  • Odds Ratio
  • Perinatal Death*
  • Pre-Eclampsia / epidemiology*
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / epidemiology*
  • Pregnancy Outcome / epidemiology
  • Pregnancy, Twin
  • Premature Birth / epidemiology*
  • Registries*
  • Retrospective Studies
  • Scotland / epidemiology
  • Stillbirth / epidemiology*
  • Uterine Hemorrhage / epidemiology*
  • Young Adult