Impact of fertility treatment on severe maternal morbidity

Autor: Erica T. Wang, Naomi Greene, Lauren Ramos, Nina Vyas, Margareta D. Pisarska, John A. Ozimek, Sarah J. Kilpatrick
Rok vydání: 2016
Předmět:
Adult
medicine.medical_specialty
Blood transfusion
Multivariate analysis
Pregnancy Rate
Reproductive Techniques
Assisted
media_common.quotation_subject
medicine.medical_treatment
Fertility
Fertilization in Vitro
Risk Assessment
Severity of Illness Index
Article
Medical Records
law.invention
03 medical and health sciences
0302 clinical medicine
Pregnancy
Risk Factors
law
medicine
Humans
030212 general & internal medicine
reproductive and urinary physiology
Retrospective Studies
media_common
Academic Medical Centers
030219 obstetrics & reproductive medicine
Eclampsia
Obstetrics
business.industry
Medical record
Obstetrics and Gynecology
Retrospective cohort study
medicine.disease
Intensive care unit
Pregnancy Complications
Logistic Models
Treatment Outcome
Reproductive Medicine
Infertility
Multivariate Analysis
Gestation
Female
business
Live Birth
Zdroj: Fertility and Sterility. 106:423-426
ISSN: 0015-0282
DOI: 10.1016/j.fertnstert.2016.03.039
Popis: Objective To determine if fertility treatment is associated with increased risk of severe maternal morbidity (SMM) compared with spontaneous pregnancies. Design Retrospective cohort study. Setting Academic medical center. Patient(s) In 2012, 6,543 women delivered live births >20 weeks gestation at our center. Women were categorized based on mode of conception: in vitro fertilization (IVF), non-IVF fertility treatment (NIFT), or spontaneous pregnancies. Intervention(s) None. Main Outcome Measure(s) The main outcome was presence of true SMM, such as eclampsia, respiratory failure, and peripartum hysterectomy. Deliveries were screened with the use of: 1) International Classification of Diseases 9 codes; 2) prolonged postpartum stay; 3) maternal intensive care unit admissions, and 4) blood transfusion. The charts of women meeting the screening criteria were reviewed to identify true SMM based on a previously validated method, recognizing that medical record review is the criterion standard. Result(s) Of the 6,543 deliveries, 246 (3.8%) were IVF conceptions and 109 (1.7%) NIFT conceptions. Sixty-nine cases of true SMM were identified (1.1%). In multivariate analyses, any fertility treatment (IVF + NIFT) was associated with increased risk of SMM compared with spontaneous conceptions. In a subset analysis of singletons only, the association between any fertility treatment (IVF + NIFT) and SMM was not statistically significant. Conclusion(s) Overall, fertility treatment increased risk for SMM events. Given the limited sample size, the negative finding with singleton gestations is inconclusive. Larger multicenter studies with accurate documentation of fertility treatment and SMM cases are needed to further clarify the risk associated with singletons.
Databáze: OpenAIRE
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