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Risk of spontaneous preterm birth in singleton pregnancies conceived after IVF/ICSI treatment: meta-analysis of cohort studies
- Source :
- Ultrasound in Obstetrics & Gynecology. 51:43-53
- Publication Year :
- 2018
- Publisher :
- Wiley, 2018.
-
Abstract
- Objective: Preterm birth (PTB) is more common in pregnancies conceived by in-vitro fertilization (IVF) as compared with those conceived naturally. However, the extent to which this is attributed to spontaneous labor or to iatrogenic indications has not been determined. The aim of this study was to quantify the risk of spontaneous PTB (sPTB) in singleton pregnancies resulting from IVF or intracytoplasmic sperm injection (ICSI) treatment as compared with that in spontaneously conceived pregnancies. Methods: An electronic search of PubMed/MEDLINE, Scopus and Web of Science to September 2017 and manual search of reference lists identified articles comparing the risk of sPTB in IVF/ICSI vs spontaneously conceived singleton pregnancies. Inclusion criteria were singleton conception with IVF/ICSI, PTB defined as delivery before 37 weeks' gestation and cohort design with clear distinction between spontaneous and indicated PTB. The primary outcome was sPTB < 37 weeks. Relevant secondary outcomes were also analyzed, including sPTB < 34 and < 32 weeks, preterm prelabor rupture of membranes, stillbirth, perinatal mortality, neonatal sepsis, respiratory distress syndrome and gastrointestinal morbidity. A meta-analysis provided the estimation of risk of sPTB in IVF/ICSI pregnancies. Results: In total, 674 records were identified from the search, of which 15 met the inclusion criteria and were included in the meta-analysis. A pooled crude analysis of the primary outcome generated a total sample size of 61 677 births, including 8044 singletons conceived after IVF/ICSI and 53 633 conceived spontaneously. A pooled crude data analysis showed a significant increase in the incidence of sPTB < 37 weeks in singleton IVF/ICSI pregnancies compared with those conceived spontaneously (810/8044 (10.1%) vs 2932/53 633 (5.5%); odds ratio (OR), 1.75; 95% CI, 1.50â2.03; I2= 39%). A subgroup analysis of studies matching for maternal age and parity confirmed the finding (OR, 1.63; 95% CI, 1.30â2.05; I2= 33%). A pooled crude analysis of secondary outcomes showed a significant increase in the incidence of sPTB < 34 weeks in pregnancies conceived after IVF/ICSI compared with those conceived spontaneously (37/1012 (3.6%) vs 24/1107 (2.2%); OR, 1.78; 95% CI, 1.03â3.08; I2= 6%) and did not show any significant difference for any of the other secondary outcomes analyzed. The quality of evidence, rated using the GRADE criteria, was low for the outcome sPTB < 37 weeks and very low for sPTB < 34 weeks. Conclusions: The risk of sPTB in singleton pregnancies resulting from IVF/ICSI is significantly greater than that in spontaneously conceived singletons. These findings should be interpreted with caution given the low quality of the available evidence. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
- Subjects :
- Radiology, Nuclear Medicine and Imaging
medicine.medical_treatment
intracytoplasmic sperm injection
assisted reproductive technologie
Intracytoplasmic sperm injection
Cohort Studies
0302 clinical medicine
Obstetrics and gynaecology
Pregnancy
Risk Factors
spontaneous preterm birth
Medicine
030212 general & internal medicine
reproductive and urinary physiology
030219 obstetrics & reproductive medicine
Radiological and Ultrasound Technology
Incidence
Pregnancy Outcome
Obstetrics and Gynecology
Gestational age
General Medicine
IVF
Premature birth
in-vitro fertilization
Premature Birth
Female
preterm delivery
ART
Human
Cohort study
preterm labor
medicine.medical_specialty
Gestational Age
Fertilization in Vitro
ICSI
03 medical and health sciences
Spontaneous conception
Humans
Radiology, Nuclear Medicine and imaging
Sperm Injections, Intracytoplasmic
Gynecology
In vitro fertilisation
urogenital system
business.industry
Risk Factor
prematurity
Infant, Newborn
medicine.disease
Reproductive Medicine
Cohort Studie
business
Subjects
Details
- ISSN :
- 09607692
- Volume :
- 51
- Database :
- OpenAIRE
- Journal :
- Ultrasound in Obstetrics & Gynecology
- Accession number :
- edsair.doi.dedup.....4e587a82789c8829e25f262cbfd85f93