Intrapartum and neonatal outcomes in singleton pregnancies following conception by assisted reproduction techniques

Assisted Reproductive Technologies: A New Player in the Foetal Programming of Childhood and Adult Diseases?

Assisted reproductive technology (ART) is an emerging field in medicine that incorporates complex procedures and has profound ethical, moral, social, religious, and economic implications not just for the individuals who have access to this method but also for society. In this narrative review, we summarise multiple aspects of ART procedures and the possible consequences on the mother and newborn. Moreover, we provide an overview of the possible long-term consequences of ART procedures on the health of newborns, although longitudinal evidence is particularly scant. Users should be informed that ART procedures are not risk-free to prepare them for the possible negative outcomes that may occur in the perinatal period or even in childhood and adulthood. Indeed, risk estimates point to increased liability for major nonchromosomal birth defects; cardiovascular, musculoskeletal, and urogenital (in male newborns) defects; and any other birth defects. Less certainty is present for the risk of neuropsychiatric sequelae in children conceived through ART. Thus, its application should be accompanied by adequate counselling and psychological support, possibly integrated into specific multidisciplinary clinical programmes.

The influence of regulation of medically assisted reproduction on the risk of hospitalization in the first 2 years of life

STUDY QUESTION

Do publicly funded fertility treatment and single embryo transfer (SET) result in lower hospitalization rates of children of parents with infertility?

SUMMARY ANSWER

Following the 2010 Quebec law introducing free fertility treatment and SET, neonatal intensive care unit (NICU) admissions decreased among all children born to parents with infertility, but not among singletons, whose risk remained slightly higher than that of children of parents without infertility, even accounting for treatment and maternal age.

WHAT IS KNOWN ALREADY

Previous studies reported lower NICU admission rates among children conceived with ART after the 2010 law; however, children conceived without ART by parents with infertility were not considered.

STUDY DESIGN, SIZE, DURATION

Cohort study of children born in 1997-2017 to patients evaluated for infertility ('exposed') at an academic fertility center in Montreal (Canada) in 1996-2015. A random sample of births to Montreal residents served as comparison. Outcomes were identified from Quebec administrative databases.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We compared children's healthcare utilization before and after the 2010 law in 6273 exposed and 12 583 randomly sampled births (6846 and 12 775 children, respectively). We repeated the analysis among children conceived in the 63 months before and after the law ('restricted period'), and examined whether differences in twinning, fertility treatment, and maternal age explained the higher risk of NICU admission among children of parents with infertility.

MAIN RESULTS AND THE ROLE OF CHANCE

In the exposed cohort, the proportion of twin births and of several adverse outcomes declined after the law. NICU admission and duration of NICU stay decreased overall, but not in singletons. Both measures remained higher in exposed children. Except for NICU admission, hospitalization rates were similar in exposed and random sample children. After accounting for fertility treatment and maternal age, exposed singletons were 17% more likely to be admitted to the NICU than children of parents with no medical history of infertility.

LIMITATIONS, REASONS FOR CAUTION

Sample size was relatively small; infertile patients were from a single center and the random sample from one city. Despite some limitations, administrative databases are likely to accurately reflect healthcare utilization.

WIDER IMPLICATIONS OF THE FINDINGS

Universal access to treatment and, particularly, SET results in an overall reduction of adverse outcomes among children conceived with treatment; however, children of parents with infertility are at a slightly higher risk, regardless of treatment.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Canadian Institutes for Health Research (CIHR, grant no. 123362). No competing interests.

TRIAL REGISTRATION NUMBER

N/A.

Maternal and Neonatal Outcomes After Assisted Reproductive Technology: A Retrospective Cohort Study in China

Background

With the progress of assisted reproductive technology (ART) and the increasing number of ART pregnancy, its safety has become the focus of attention. The present study aimed to explore the associations of ART pregnancy with maternal and neonatal outcomes, as compared with naturally pregnancy.

Methods

This retrospective cohort study included all pregnant women who delivered at Women’s Hospital of Nanjing Medical University in 2011–2020. We compared maternal characteristics and pregnancy outcomes between group of ART pregnancy and group of naturally pregnancy using Logistic regression adjusted for confounders.

Results

A total of 13,604 ART pregnancies and 198,002 naturally pregnancies were included. The proportion of ART pregnancies has increased every year for the past 10 years, peaking in 2020 (9.0%). Multivariable logistic regression analysis showed that the risks of gestational diabetes, preeclampsia, moderate or severe anemia, liver-related diseases, thyroid-related diseases, preterm birth, placenta previa, postpartum hemorrhage, and cesarean section were significantly increased in ART pregnancy. For neonatal outcomes, women conceived by ART were more likely to have twins or multiples, and the risk of stillbirth or abnormal development was also significantly increased. When restriction to singletons, these risks were reduced. And the effects of ART on the risk of premature rupture of membrane, cord entanglement, intrapartum fever, cesarean section, and stillbirth or abnormal development were more pronounced in singletons pregnancies compared with that in pregnancies of twins or multiples.

Conclusion

Women conceived by ART were at increased risks of several adverse pregnancy outcomes compared with women conceived naturally. Multiple pregnancies could partly explain this phenomenon. For ART pregnancy, prenatal and intrapartum monitoring should be strengthened, and neonatal outcomes should be closely observed.

Examination of fetal growth trajectories following infertility treatment

PURPOSE

The objective of this retrospective cohort study was to compare fetal growth during the second and third trimesters for ovulation induction with intrauterine insemination (IUI), fresh embryo transfer (ET), frozen embryo transfer (FET), and spontaneous conception following infertility.

METHODS

Three hundred ninety-five women with viable pregnancies confirmed at a single academic fertility center participated. All women achieved pregnancy either by treatment or spontaneously after a diagnosis of infertility. Inclusion criteria included autologous singleton pregnancies. Exclusion criteria included pregnancies from donor oocytes, twins, unavailable ultrasound data, and treatment methods with small number of participants. Primary outcomes of interest were head circumference (HC), abdominal circumference (AC), HC/AC ratio, and estimated fetal weight (EFW). Conditional growth curve models were created, and growth curves were selected for each outcome of interest.

RESULTS

For ovulation induction with IUI, fresh ET, FET, and spontaneous conception, the slope analysis of growth curves for per-week growth rate of HC, AC, HC/AC ratio, and EFW demonstrated no difference. A subgroup analysis of fresh ET and FET groups, for same outcomes, also showed no difference.

CONCLUSION

These findings contribute to the very limited literature on fetal growth trajectories following infertility treatment and suggest no significant differences in fetal growth for ovulation induction with IUI, fresh ET, FET, and spontaneous conception following infertility. It is possible there were no differences in growth trajectories between these conception methods because the majority of children born following infertility are of normal birth weight. While results are reassuring, further research with larger populations is warranted.

Factors associated with intrapartum cesarean section in women aged 40 years or older: a single-center experience in Japan

Objective: To elucidate the efficacy and safety of attempting a vaginal birth and to understand the factors that contribute to the increased risk of operative delivery in women aged 40 years or older.Methods: A database of the Japanese Red Cross Nagoya Daiichi Hospital was reviewed to identify women aged 40 years or older with singleton, vertex, and vital pregnancies who attempted vaginal delivery at and after 37 + 0 gestational weeks between January 2011 and December 2016.Results: A total of 415 women met the criteria for inclusion in this study, including 372 and 43 women who gave birth by vaginal delivery and by intrapartum cesarean section (CS), respectively. Vaginal delivery was observed in 84.1% (201/239) and 97.2% (171/176) of nulliparous and multiparous women, respectively. In a logistic regression model, nulliparity [odds ratio (OR), 5.18; 95% confidence interval (CI), 1.91-14.00], assisted reproductive technology (OR, 2.83; 95% CI, 1.42-5.62), and admission for induction of childbirth (OR, 2.68; 95% CI, 1.08-6.67) were associated with a higher likelihood of intrapartum CS. Of 372 women who delivered vaginally, 62 women needed operative delivery. Operative delivery was necessary for 25.4% (51/201) and 6.4% (11/171) of nulliparous and multiparous women, respectively. A logistic regression model identified nulliparity (OR, 3.91; 95% CI, 1.89-8.08) and administration of ecbolic (OR, 2.49; 95% CI, 1.21-5.10) as being independent factors associated with vacuum extraction.Conclusions: Maternal age 40 years or older should not be a barrier for attempting a vaginal delivery, and those women should be encouraged to attempt a vaginal delivery.