Obstetric consequences of subfertility: a retrospective cohort study.

Abstract

OBJECTIVE:

To compare the risk of adverse pregnancy outcomes in women with and without subfertility and to investigate whether fertility treatment contributes to the adverse outcomes.

DESIGN:

Register-based retrospective cohort study.

SETTING:

Aberdeen, Scotland

POPULATION:

The exposed group included women with subfertility attending Aberdeen Fertility Clinic between 1989 and 2008 and delivering a singleton (n = 3188) or twin (n = 350) at Aberdeen Maternity Hospital between 1992 and 2009. The unexposed cohort included the remainder of women (singleton n = 52443, twin n = 1125) delivering at Aberdeen Maternity Hospital between 1992 and 2009.

METHODS:

The Aberdeen Fertility Centre database and Aberdeen Maternity and Neonatal Databank were linked using Community Health Index numbers. Regression models were used to calculate risk ratios and 95% confidence intervals adjusting for potential confounders.

MAIN OUTCOME MEASURES:

Maternal outcomes including pre-eclampsia, antepartum haemorrhage, preterm birth, induction of labour; delivery outcomes including operative vaginal delivery, caesarean section; and offspring outcomes including low birthweight, stillbirth and neonatal death.

RESULTS:

Women with a history of subfertility who delivered a singleton were at a higher risk of pre-eclampsia [adjusted risk ratios (aRR) 1.18, 95% confidence intervals (CI) 1.02-1.37], antepartum haemorrhage (aRR 1.32, 95% CI 1.18-1.47), induction of labour (aRR 1.21, 95% CI 1.11-1.31) and very preterm delivery (<32 weeks) (aRR 1.96, 95% CI 1.53-2.49). Subfertile women delivering twins were at a higher risk of being delivered by emergency caesarean section (aRR 2.14, 95% CI 1.26-3.66). There were no significant differences in adverse outcomes for singleton pregnancies between the treated and untreated subfertile couples.

CONCLUSION:

Subfertility per se, rather than fertility treatment, was associated with increased risk of adverse outcomes in singleton pregnancies.

TWEETABLE ABSTRACT:

Large cohort study found higher incidence of adverse outcome in subfertile women having singletons or twins.

• Authors: A L DoPierala, S Bhatta, E A Raja, S Bhattacharya, S Bhattacharya
• Journal: BJOG : an international journal of obstetrics and gynaecology (BJOG) Vol. 123 Issue 8 Pg. 1320-8 (Jul 2016) ISSN: 1471-0528 [Electronic] England
• PMID: 26335260 (Publication Type: Journal Article, Video-Audio Media)
• Copyright: © 2015 Royal College of Obstetricians and Gynaecologists.

Topics

• Adult
• Case-Control Studies
• Cesarean Section (statistics & numerical data)
• Cohort Studies
• Delivery, Obstetric
• Female
• Humans
• Incidence
• Infant, Low Birth Weight
• Infant, Newborn
• Infertility, Female (epidemiology)
• Information Storage and Retrieval
• Labor, Induced (statistics & numerical data)
• Multivariate Analysis
• Odds Ratio
• Perinatal Death
• Pre-Eclampsia (epidemiology)
• Pregnancy
• Pregnancy Complications, Cardiovascular (epidemiology)
• Pregnancy Outcome (epidemiology)
• Pregnancy, Twin
• Premature Birth (epidemiology)
• Registries
• Retrospective Studies
• Scotland (epidemiology)
• Stillbirth (epidemiology)
• Uterine Hemorrhage (epidemiology)
• Young Adult