Adverse Obstetric and Perinatal Outcomes in Subfertile Women Conceiving Without Assisted Reproductive Technologies

作者：Jaques Alice M^*; Amor David J; Baker H W Gordon; Healy David L; Ukoumunne Obioha C; Breheny Sue; Garrett Claire; Halliday Jane L

来源：Obstetrical and Gynecological Survey, 2011, 66(4): 203-204.

DOI：10.1097/OGX.0b013e318225c60b

It is unclear whether assisted reproductive technologies (ART) or factors associated with infertility contribute to adverse perinatal outcomes in subfertile women who undergo in vitro fertilization. Some investigators have suggested that specific effects of ART due to the laboratory procedures are largely responsible for adverse perinatal outcomes. Others believe that procedures involved with in vitro fertilization are not causative, but factors related to the health of the infertile woman are responsible.
This cohort study compared the prevalence of adverse perinatal birth outcomes among subfertile women who conceived and delivered without ART and women from the general population (controls). The study subjects were 2171 subfertile women who registered at 2 fertility clinics and subsequently conceived and gave birth to singleton infants without ART. A total of 4363 controls, matched by maternal age and year of infant's birth were selected randomly from birth records. The primary study outcome measures were adverse obstetric and perinatal outcomes. Multivariable analysis was used to adjust for known confounders.
Compared with controls, there were increased odds among subfertile women of hypertension or preeclampsia (adjusted odds ratio [aOR], 1.29; 95% confidence interval [CI], 1.02-1.61); antepartum hemorrhage (aOR, 1.41; 95% CI, 1.05-1.89); preterm birth < 37 weeks (aOR, 1.32; 95% CI, 1.05-1.67) or < 31 weeks (aOR; 2.37; 95% CI, 1.35-4.13); low birth weight (aOR, 1.44; 95% CI, 1.11-1.85); perinatal death (aOR, 2.19; 95% CI, 1.10-4.36); and cesarean delivery (aOR, 1.56; 95% CI, 1.37-1.77; P values for all these comparisons were < 0.05). Only weak evidence was found in subfertile women for increased risk of gestational diabetes (aOR, 1.25; 95% CI, 0.96-1.63; P < 0.09) or birth defects (aOR, 1.30; 95% CI, 0.98-1.72; P < 0.07). There was no increased risk for prelabor rupture of membranes, small for gestational age, or postpartum hemorrhage.
These findings show that subfertile singleton women who conceive without ART are at increased risk of several adverse perinatal outcomes. These data suggest more careful monitoring of subfertile women during antenatal care.

• 出版日期2011-4