Risk of Severe Maternal Morbidity by Maternal Fertility Status: A US Study in Eight States

Barbara Luke, Morton B. Brown, Ethan Wantman, Valerie L. Baker, Kevin J. Doody, David B. Seifer, Logan G. Spector

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND Over the past two decades the characteristics of women giving birth in the United States and the nature of the births themselves have changed dramatically, with increases in older maternal age, plural births, cesarean deliveries, and conception from infertility treatment. OBJECTIVE To evaluate the risk of severe maternal morbidity by maternal fertility status, and for IVF pregnancies, by oocyte source and embryo state combinations. STUDY DESIGN Women in eight States who underwent in vitro fertilization (IVF) cycles resulting in a live birth during 2004-13 were linked to their infant’s birth certificates; a 10:1 sample of births from non-IVF deliveries were selected for comparison; those with an indication of infertility treatment on the birth certificate were categorized as subfertile, all others were categorized as fertile. IVF pregnancies were additionally categorized by oocyte source (autologous vs donor) and embryo state (fresh vs thawed). Maternal morbidity was identified from the birth certificate, modeled using logistic regression, and reported as adjusted odds ratios and 95% confidence intervals [AOR (95% CI)]. The reference group was fertile women. RESULTS The study population included 1,477,522 pregnancies (1,346,118 fertile, 11,298 subfertile, 80,254 IVF autologous-fresh, 21,964 IVF autologous-thawed, 13,218 IVF donor-fresh and 4,670 IVF donor-thawed pregnancies); 1,420,529 singleton, 54,573 twin, and 2,420 triplet+ pregnancies. Compared to fertile women, subfertile and the four groups of IVF-treated women had increased risks for blood transfusion and 3rd or 4th degree perineal laceration (subfertile, 1.58 [1.23, 2.02] and 2.08 [1.79, 2.43]; autologous-fresh, 1.33 [1.14, 1.54] and 1.37 [1.26, 1.49]; autologous-thawed, 1.94 [1.60, 2.36] and 2.10 [1.84, 2.40]; donor-fresh 2.16 [1.69, 2.75] and 2.11 [1.66, 2.69]; and donor-thawed, 2.01 [1.38, 2.92] and 1.28 [0.79, 2.08]). Also compared to fertile women, the risk of unplanned hysterectomy was increased for IVF-treated women in the autologous-thawed group (2.80, [1.96, 4.00]), donor-fresh group (2.14 [1.33, 3.44], and the donor-thawed group (2.46 [1.33, 4.54]). The risk of ruptured uterus was increased for IVF-treated women in the autologous-fresh group (1.62 [1.14, 2.29]). Among women with a prior birth, the risk of blood transfusion after a vaginal birth was increased for subfertile women (2.91 [1.38, 6.15]), and women in all four IVF groups (autologous-fresh, 1.93 [1.23, 3.01]; autologous-thawed, 2.99 [1.78, 5.02]; donor-fresh, 5.13 [2.39, 11.02]; and donor-thawed, 5.20 [1.83, 14.82]; the risk after a cesarean delivery was increased in the autologous-thawed group (1.74 [1.29, 2.33]) and the donor-fresh group (1.62 [1.07, 2.45]). Unplanned hysterectomy was increased in the autologous-thawed (2.31, [1.43, 3.71]) and donor-thawed groups (2.45 [1.06, 5.67]). CONCLUSIONS The risks of severe maternal morbidity are increased for subfertile and IVF births, particularly in pregnancies that are not from autologous, fresh cycles.
Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
DOIs
StatePublished - 2018

Fingerprint

Fertilization in Vitro
Fertility
Mothers
Morbidity
Tissue Donors
Parturition
Birth Certificates
Pregnancy
Hysterectomy
Blood Transfusion
Infertility
Oocytes
Embryonic Structures
Triplet Pregnancy
Lacerations
Maternal Age
Live Birth
Fertilization
Uterus
Logistic Models

PubMed: MeSH publication types

  • Journal Article
  • Observational Study
  • Research Support, N.I.H., Extramural

Cite this

Risk of Severe Maternal Morbidity by Maternal Fertility Status: A US Study in Eight States. / Luke, Barbara; Brown, Morton B.; Wantman, Ethan; Baker, Valerie L.; Doody, Kevin J.; Seifer, David B.; Spector, Logan G.

In: American Journal of Obstetrics and Gynecology, 2018.

Research output: Contribution to journalArticle

Luke, Barbara ; Brown, Morton B. ; Wantman, Ethan ; Baker, Valerie L. ; Doody, Kevin J. ; Seifer, David B. ; Spector, Logan G. / Risk of Severe Maternal Morbidity by Maternal Fertility Status: A US Study in Eight States. In: American Journal of Obstetrics and Gynecology. 2018.
@article{2c19b7ed7b534cd6bd9ad03b008ef2ed,
title = "Risk of Severe Maternal Morbidity by Maternal Fertility Status: A US Study in Eight States",
abstract = "BACKGROUND Over the past two decades the characteristics of women giving birth in the United States and the nature of the births themselves have changed dramatically, with increases in older maternal age, plural births, cesarean deliveries, and conception from infertility treatment. OBJECTIVE To evaluate the risk of severe maternal morbidity by maternal fertility status, and for IVF pregnancies, by oocyte source and embryo state combinations. STUDY DESIGN Women in eight States who underwent in vitro fertilization (IVF) cycles resulting in a live birth during 2004-13 were linked to their infant’s birth certificates; a 10:1 sample of births from non-IVF deliveries were selected for comparison; those with an indication of infertility treatment on the birth certificate were categorized as subfertile, all others were categorized as fertile. IVF pregnancies were additionally categorized by oocyte source (autologous vs donor) and embryo state (fresh vs thawed). Maternal morbidity was identified from the birth certificate, modeled using logistic regression, and reported as adjusted odds ratios and 95{\%} confidence intervals [AOR (95{\%} CI)]. The reference group was fertile women. RESULTS The study population included 1,477,522 pregnancies (1,346,118 fertile, 11,298 subfertile, 80,254 IVF autologous-fresh, 21,964 IVF autologous-thawed, 13,218 IVF donor-fresh and 4,670 IVF donor-thawed pregnancies); 1,420,529 singleton, 54,573 twin, and 2,420 triplet+ pregnancies. Compared to fertile women, subfertile and the four groups of IVF-treated women had increased risks for blood transfusion and 3rd or 4th degree perineal laceration (subfertile, 1.58 [1.23, 2.02] and 2.08 [1.79, 2.43]; autologous-fresh, 1.33 [1.14, 1.54] and 1.37 [1.26, 1.49]; autologous-thawed, 1.94 [1.60, 2.36] and 2.10 [1.84, 2.40]; donor-fresh 2.16 [1.69, 2.75] and 2.11 [1.66, 2.69]; and donor-thawed, 2.01 [1.38, 2.92] and 1.28 [0.79, 2.08]). Also compared to fertile women, the risk of unplanned hysterectomy was increased for IVF-treated women in the autologous-thawed group (2.80, [1.96, 4.00]), donor-fresh group (2.14 [1.33, 3.44], and the donor-thawed group (2.46 [1.33, 4.54]). The risk of ruptured uterus was increased for IVF-treated women in the autologous-fresh group (1.62 [1.14, 2.29]). Among women with a prior birth, the risk of blood transfusion after a vaginal birth was increased for subfertile women (2.91 [1.38, 6.15]), and women in all four IVF groups (autologous-fresh, 1.93 [1.23, 3.01]; autologous-thawed, 2.99 [1.78, 5.02]; donor-fresh, 5.13 [2.39, 11.02]; and donor-thawed, 5.20 [1.83, 14.82]; the risk after a cesarean delivery was increased in the autologous-thawed group (1.74 [1.29, 2.33]) and the donor-fresh group (1.62 [1.07, 2.45]). Unplanned hysterectomy was increased in the autologous-thawed (2.31, [1.43, 3.71]) and donor-thawed groups (2.45 [1.06, 5.67]). CONCLUSIONS The risks of severe maternal morbidity are increased for subfertile and IVF births, particularly in pregnancies that are not from autologous, fresh cycles.",
author = "Barbara Luke and Brown, {Morton B.} and Ethan Wantman and Baker, {Valerie L.} and Doody, {Kevin J.} and Seifer, {David B.} and Spector, {Logan G.}",
year = "2018",
doi = "10.1016/J.AJOG.2018.10.012",
language = "English (US)",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Risk of Severe Maternal Morbidity by Maternal Fertility Status: A US Study in Eight States

AU - Luke, Barbara

AU - Brown, Morton B.

AU - Wantman, Ethan

AU - Baker, Valerie L.

AU - Doody, Kevin J.

AU - Seifer, David B.

AU - Spector, Logan G.

PY - 2018

Y1 - 2018

N2 - BACKGROUND Over the past two decades the characteristics of women giving birth in the United States and the nature of the births themselves have changed dramatically, with increases in older maternal age, plural births, cesarean deliveries, and conception from infertility treatment. OBJECTIVE To evaluate the risk of severe maternal morbidity by maternal fertility status, and for IVF pregnancies, by oocyte source and embryo state combinations. STUDY DESIGN Women in eight States who underwent in vitro fertilization (IVF) cycles resulting in a live birth during 2004-13 were linked to their infant’s birth certificates; a 10:1 sample of births from non-IVF deliveries were selected for comparison; those with an indication of infertility treatment on the birth certificate were categorized as subfertile, all others were categorized as fertile. IVF pregnancies were additionally categorized by oocyte source (autologous vs donor) and embryo state (fresh vs thawed). Maternal morbidity was identified from the birth certificate, modeled using logistic regression, and reported as adjusted odds ratios and 95% confidence intervals [AOR (95% CI)]. The reference group was fertile women. RESULTS The study population included 1,477,522 pregnancies (1,346,118 fertile, 11,298 subfertile, 80,254 IVF autologous-fresh, 21,964 IVF autologous-thawed, 13,218 IVF donor-fresh and 4,670 IVF donor-thawed pregnancies); 1,420,529 singleton, 54,573 twin, and 2,420 triplet+ pregnancies. Compared to fertile women, subfertile and the four groups of IVF-treated women had increased risks for blood transfusion and 3rd or 4th degree perineal laceration (subfertile, 1.58 [1.23, 2.02] and 2.08 [1.79, 2.43]; autologous-fresh, 1.33 [1.14, 1.54] and 1.37 [1.26, 1.49]; autologous-thawed, 1.94 [1.60, 2.36] and 2.10 [1.84, 2.40]; donor-fresh 2.16 [1.69, 2.75] and 2.11 [1.66, 2.69]; and donor-thawed, 2.01 [1.38, 2.92] and 1.28 [0.79, 2.08]). Also compared to fertile women, the risk of unplanned hysterectomy was increased for IVF-treated women in the autologous-thawed group (2.80, [1.96, 4.00]), donor-fresh group (2.14 [1.33, 3.44], and the donor-thawed group (2.46 [1.33, 4.54]). The risk of ruptured uterus was increased for IVF-treated women in the autologous-fresh group (1.62 [1.14, 2.29]). Among women with a prior birth, the risk of blood transfusion after a vaginal birth was increased for subfertile women (2.91 [1.38, 6.15]), and women in all four IVF groups (autologous-fresh, 1.93 [1.23, 3.01]; autologous-thawed, 2.99 [1.78, 5.02]; donor-fresh, 5.13 [2.39, 11.02]; and donor-thawed, 5.20 [1.83, 14.82]; the risk after a cesarean delivery was increased in the autologous-thawed group (1.74 [1.29, 2.33]) and the donor-fresh group (1.62 [1.07, 2.45]). Unplanned hysterectomy was increased in the autologous-thawed (2.31, [1.43, 3.71]) and donor-thawed groups (2.45 [1.06, 5.67]). CONCLUSIONS The risks of severe maternal morbidity are increased for subfertile and IVF births, particularly in pregnancies that are not from autologous, fresh cycles.

AB - BACKGROUND Over the past two decades the characteristics of women giving birth in the United States and the nature of the births themselves have changed dramatically, with increases in older maternal age, plural births, cesarean deliveries, and conception from infertility treatment. OBJECTIVE To evaluate the risk of severe maternal morbidity by maternal fertility status, and for IVF pregnancies, by oocyte source and embryo state combinations. STUDY DESIGN Women in eight States who underwent in vitro fertilization (IVF) cycles resulting in a live birth during 2004-13 were linked to their infant’s birth certificates; a 10:1 sample of births from non-IVF deliveries were selected for comparison; those with an indication of infertility treatment on the birth certificate were categorized as subfertile, all others were categorized as fertile. IVF pregnancies were additionally categorized by oocyte source (autologous vs donor) and embryo state (fresh vs thawed). Maternal morbidity was identified from the birth certificate, modeled using logistic regression, and reported as adjusted odds ratios and 95% confidence intervals [AOR (95% CI)]. The reference group was fertile women. RESULTS The study population included 1,477,522 pregnancies (1,346,118 fertile, 11,298 subfertile, 80,254 IVF autologous-fresh, 21,964 IVF autologous-thawed, 13,218 IVF donor-fresh and 4,670 IVF donor-thawed pregnancies); 1,420,529 singleton, 54,573 twin, and 2,420 triplet+ pregnancies. Compared to fertile women, subfertile and the four groups of IVF-treated women had increased risks for blood transfusion and 3rd or 4th degree perineal laceration (subfertile, 1.58 [1.23, 2.02] and 2.08 [1.79, 2.43]; autologous-fresh, 1.33 [1.14, 1.54] and 1.37 [1.26, 1.49]; autologous-thawed, 1.94 [1.60, 2.36] and 2.10 [1.84, 2.40]; donor-fresh 2.16 [1.69, 2.75] and 2.11 [1.66, 2.69]; and donor-thawed, 2.01 [1.38, 2.92] and 1.28 [0.79, 2.08]). Also compared to fertile women, the risk of unplanned hysterectomy was increased for IVF-treated women in the autologous-thawed group (2.80, [1.96, 4.00]), donor-fresh group (2.14 [1.33, 3.44], and the donor-thawed group (2.46 [1.33, 4.54]). The risk of ruptured uterus was increased for IVF-treated women in the autologous-fresh group (1.62 [1.14, 2.29]). Among women with a prior birth, the risk of blood transfusion after a vaginal birth was increased for subfertile women (2.91 [1.38, 6.15]), and women in all four IVF groups (autologous-fresh, 1.93 [1.23, 3.01]; autologous-thawed, 2.99 [1.78, 5.02]; donor-fresh, 5.13 [2.39, 11.02]; and donor-thawed, 5.20 [1.83, 14.82]; the risk after a cesarean delivery was increased in the autologous-thawed group (1.74 [1.29, 2.33]) and the donor-fresh group (1.62 [1.07, 2.45]). Unplanned hysterectomy was increased in the autologous-thawed (2.31, [1.43, 3.71]) and donor-thawed groups (2.45 [1.06, 5.67]). CONCLUSIONS The risks of severe maternal morbidity are increased for subfertile and IVF births, particularly in pregnancies that are not from autologous, fresh cycles.

U2 - 10.1016/J.AJOG.2018.10.012

DO - 10.1016/J.AJOG.2018.10.012

M3 - Article

C2 - 30321527

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

ER -