Preprint
Maternal morbidity and medically assisted reproduction treatment types: evidence from the Utah Population Database
Pelikh, A., Smith, K. R.,
Myrskylä, M., Debbink, M. P., Goisis, A.
medRxiv preprints
40 pages.
medRxiv
originally posted on: 12 August 2024 (2024), unpublished
Abstract
Study question: How are Medically Assisted Reproduction (MAR) treatments (Fertility enhancing drugs (FED), artificial/intrauterine insemination (AI/IUI)), assisted reproductive technology (ART) with autologous/donor oocytes) associated with maternal morbidity (MM)? Summary answer: More invasive MAR treatments (ART and AI/IUI) are associated with higher risk of MM, whilst less invasive treatments are not; this relationship is partially explained by higher prevalence of multifetal gestation and obstetric comorbidities in women undergoing more invasive treatment, but the persistent association suggests subfertility itself may contribute to maternal morbidity risk. What is known already: Women conceiving through MAR are at higher risk of MM, however, reported risks vary depending on the measurement of MM and data available on confounding. Study design, size, duration: Birth certificates were used to study maternal morbidity among all women giving birth in Utah, U.S., between 2009 and 2017 (N=460,976 deliveries); 19,448 conceived through MAR (4.2%). The MM outcome measure included the presence of any of the following: blood transfusion; unplanned operating room procedure; admission to ICU; eclampsia; unplanned hysterectomy; ruptured uterus. Participants/materials, setting, methods: Logistic regressions were estimated for the binary outcome (presence of any of the MM conditions). We assessed MM among women conceiving through MAR (overall and by type of treatment) compared to those conceiving spontaneously in the overall sample before and after adjustment for maternal socio-demographic characteristics (maternal age, family structure, level of education, Hispanic origin, parity), pre-existing maternal comorbidities (i.e., chronic hypertension, heart disease, asthma), multifetal gestation, and obstetric comorbidities (i.e., placenta previa, placental abruption, preterm delivery, cesarean delivery). Main results and the role of chance: Women conceiving through MAR had higher risk of MM; however, the magnitude of the association differed depending on the type of treatment. In the unadjusted models, more invasive treatments were associated with higher odds of MM: OR 5.71 (95% CI 3.50–9.31) among women conceiving through ART with donor oocytes, OR 3.20 (95% CI 2.69–3.81) among women conceiving through ART with autologous oocytes, and OR 1.85 (95% CI 1.39–2.46) among women conceiving through AI/IUI, whereas women conceiving through FED had similar risks of MM to compared to women conceiving spontaneously (SC), OR 1.09 (95% CI 0.91–1.30). The associations between MAR and MM were largely attenuated once multifetal gestation was accounted for. After controlling for obstetric comorbidities, the associations were further attenuated, yet the coefficients remained higher among women conceiving through ART with either donor oocytes OR 1.70 (95% CI 0.95–3.04) or autologous oocytes OR 1.46 (95% CI 1.20–1.78) compared to women conceiving spontaneously. In analyses limited to singleton pregnancies, the differences in MM between women conceiving through MAR and SC were smaller in the unadjusted models. Nevertheless, women conceiving through more invasive treatments exhibited higher risk of MM. After adjusting for obstetric comorbidities, the coefficients were further attenuated and statistically insignificant for all types of treatments.