101. Risk of severe maternal morbidity associated with in vitro fertilisation: a population-based study.
- Author
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Le Ray, C, Pelage, L, Seco, A, Bouvier‐Colle, M‐H, Chantry, AA, Deneux‐Tharaux, C, Langer, Bruno, Dupont, Corinne, Rudigoz, René‐Charles, Vendittelli, Françoise, Beucher, Gaël, Rozenberg, Patrick, Carbillon, Lionel, Azria, Elie, Baunot, Nathalie, Crenn‐Hebert, Catherine, Kayem, Gilles, Fresson, Jeanne, Mignon, Alexandre, and Touzet, Sandrine
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FERTILIZATION in vitro , *HEMORRHAGE , *HYPERTENSION in pregnancy , *MULTIPLE pregnancy , *MULTIVARIATE analysis , *OVUM , *PREGNANCY complications , *PUERPERAL disorders , *RESEARCH funding , *LOGISTIC regression analysis , *CASE-control method , *ODDS ratio - Abstract
Objective: To investigate the association between in vitro fertilisation IVF and severe maternal morbidity (SMM) and to explore the role of multiple pregnancy as an intermediate factor.Design: Population-based cohort-nested case-control study.Setting: Six French regions in 2012/13.Population: Cases were 2540 women with SMM according to the EPIMOMS definition; controls were 3651 randomly selected women who gave birth without SMM.Methods: Analysis of the associations between IVF and SMM with multivariable logistic regression models, differentiating IVF with autologous oocytes (IVF-AO) from IVF with oocyte donation (IVF-OD). The contribution of multiple pregnancy as an intermediate factor was assessed by path analysis.Main Outcome Measures: Severe maternal morbidity overall and SMM according to its main underlying causal condition and by severity (near misses).Results: The risk of SMM was significantly higher in women with IVF (adjusted OR = 2.5, 95% CI 1.8-3.3). The risk of SMM was significantly higher with IVF-AO, for all-cause SMM (aOR = 2.0, 95% CI 1.5-2.7), for near misses (aOR = 1.9, 95% CI 1.3-2.8), and for intra/postpartum haemorrhages (aOR = 2.3, 95% CI 1.6-3.2). The risk of SMM was significantly higher with IVF-OD, for all-cause SMM (aOR = 18.6, 95% CI 4.4-78.5), for near misses (aOR = 18.1, 95% CI 4.0-82.3), for SMM due to hypertensive disorders (aOR = 16.7, 95% CI 3.3-85.4) and due to intra/postpartum haemorrhages (aOR = 18.0, 95% CI 4.2-77.8). Path-analysis estimated that 21.6% (95% CI 10.1-33.0) of the risk associated with IVF-OD was mediated by multiple pregnancy, and 49.6% (95% CI 24.0-75.1) of the SMM risk associated with IVF-AO.Conclusion: The risk of SMM is higher in IVF pregnancies after adjustment for confounders. Exploratory results suggest higher risks among women with IVF-OD; however, confidence intervals were wide, so this finding needs to be confirmed. A large part of the association between IVF-AO and SMM appears to be mediated by multiple pregnancy.Tweetable Abstract: The risk of severe maternal morbidity is higher in IVF-conceived pregnancies than in pregnancies conceived by other means. [ABSTRACT FROM AUTHOR]- Published
- 2019
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