The risk of perinatal and cardiometabolic complications in pregnancies conceived by medically assisted reproduction

Dovile Vilda; Elizabeth F Sutton; Venkata Sai Sahithi Kothamasu; Paul R Clisham; Cecilia T Gambala; Emily W Harville

doi:10.1007/s10815-024-03025-9

The risk of perinatal and cardiometabolic complications in pregnancies conceived by medically assisted reproduction

J Assist Reprod Genet. 2024 Mar;41(3):613-621. doi: 10.1007/s10815-024-03025-9. Epub 2024 Jan 20.

Authors

Dovile Vilda¹, Elizabeth F Sutton², Venkata Sai Sahithi Kothamasu³, Paul R Clisham³, Cecilia T Gambala⁴, Emily W Harville⁵

Affiliations

¹ Department of Social, Behavioral, and Population Sciences, Mary Amelia Center for Women's Health Equity Research, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. dvilda@tulane.edu.
² Woman's Hospital, Baton Rouge, LA, USA.
³ Tulane University School of Medicine, New Orleans, LA, USA.
⁴ Department of Obstetrics and Gynecology, Tulane University School of Medicine, New Orleans, LA, USA.
⁵ Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.

Abstract

Purpose: To examine the impact of medically assisted fertility treatments on the risk of developing perinatal and cardiometabolic complications during pregnancy and in-hospital deliveries.

Methods: We conducted a retrospective cohort study using medical health records of deliveries occurring in 2016-2022 at a women's specialty hospital in a southern state of the Unites States (US). Pregnancies achieved using medically assisted reproductive (MAR) techniques were compared with unassisted pregnancies using propensity score matching (PSM), based on demographic, preexisting health, and reproductive factors. Study outcomes included cesarean delivery, gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), delivery complications, and postpartum readmission. We used Poisson regression with robust standard errors to generate risk ratios (RRs) and 95% confidence intervals (CIs) for all study outcomes.

Results: Among 57,354 deliveries, 586 (1.02%) pregnancies were achieved using MAR and 56,768 (98.98%) were unassisted ("non-MAR"). Compared to the non-MAR group, MAR pregnancies had significantly higher prevalence of all study outcomes, including GDM (15.9% vs. 11.2%, p < 0.001), HDP (28.2% vs. 21.1%, p < 0.001), cesarean delivery (56.1% vs. 34.6%, p < 0.001), delivery complications (10.9% vs. 6.8%, p = 0.03), and postpartum readmission (4.3% vs. 2.7%, p = 0.02). In a PSM sample of 584 MAR and 1,727 unassisted pregnancies, MAR was associated with an increased risk of cesarean delivery (RR = 1.11, 95% CI = 1.01-1.22); whereas IVF was associated with an increased risk of cesarean delivery (RR = 1.15, 95% CI = 1.03-1.28) and delivery complications (RR = 1.44, 95% CI = 1.04-2.01).

Conclusions: Women who conceived with MAR were at increased risk of cesarean deliveries, and those who conceived with IVF were additionally at risk of delivery complications.

Keywords: Cardiometabolic complications; Electronic medical records; Medically assisted reproduction; Perinatal; Propensity score matching.

MeSH terms

Cardiovascular Diseases*
Diabetes, Gestational* / epidemiology
Female
Fertility
Fertilization
Humans
Pre-Eclampsia*
Pregnancy
Pregnancy Outcome / epidemiology
Retrospective Studies

Abstract

MeSH terms

Grants and funding