Obstetric consequences of subfertility: a retrospective cohort study

A. L. DoPierala, S. Bhatta, E. A. Raja, S. Bhattacharya, S. Bhattacharya

Research output: Contribution to journalArticle

5 Citations (Scopus)
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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=52443, twin=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 preeclampsia, 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 and delivering a singleton were at a higher risk of pre-eclampsia (adjusted risk ratios and 95% confidence intervals) (1.18, 1.02-1.37), antepartum haemorrhage (1.32, 1.18- 1.47), induction of labour (1.21, 1.11-1.31) and very preterm delivery (<32 weeks) (1.96, 1.53- 2.49). Subfertile women delivering twins were at a higher risk of being delivered by emergency caesarean section (2.14, 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.
Original languageEnglish
Pages (from-to)1320-1328
Number of pages9
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Volume123
Issue number8
Early online date2 Sep 2015
DOIs
Publication statusPublished - Jul 2016

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Infertility
Obstetrics
Cohort Studies
Retrospective Studies
Fertility
Induced Labor
Maternity Hospitals
Pregnancy Outcome
Pre-Eclampsia
Cesarean Section
Odds Ratio
Databases
Confidence Intervals
Hemorrhage
Stillbirth
Premature Birth
Emergencies
Mothers
Outcome Assessment (Health Care)
Pregnancy

Keywords

  • cohort study
  • obstetric outcomes
  • pregnancy complications
  • subfertility

Cite this

Obstetric consequences of subfertility : a retrospective cohort study. / DoPierala, A. L.; Bhatta, S.; Raja, E. A.; Bhattacharya, S.; Bhattacharya, S.

In: BJOG-An International Journal of Obstetrics and Gynaecology, Vol. 123, No. 8, 07.2016, p. 1320-1328.

Research output: Contribution to journalArticle

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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 studySetting: Aberdeen, ScotlandPopulation: 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=52443, twin=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 preeclampsia, 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 and delivering a singleton were at a higher risk of pre-eclampsia (adjusted risk ratios and 95{\%} confidence intervals) (1.18, 1.02-1.37), antepartum haemorrhage (1.32, 1.18- 1.47), induction of labour (1.21, 1.11-1.31) and very preterm delivery (<32 weeks) (1.96, 1.53- 2.49). Subfertile women delivering twins were at a higher risk of being delivered by emergency caesarean section (2.14, 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.",
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note = "Funding No funding was received for this study. Acknowledgements We would like to acknowledge the help and expertise provided by Fiona Chaloner who performed the data linkage and extraction from the databases. We also thank the medical statistics team, University of Aberdeen, and in particular Dr Lorna Aucott, for their advice on the analysis of the data. We would also like to thank Margery Heath for proofreading and formatting the paper.",
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AU - Bhattacharya, S.

N1 - Funding No funding was received for this study. Acknowledgements We would like to acknowledge the help and expertise provided by Fiona Chaloner who performed the data linkage and extraction from the databases. We also thank the medical statistics team, University of Aberdeen, and in particular Dr Lorna Aucott, for their advice on the analysis of the data. We would also like to thank Margery Heath for proofreading and formatting the paper.

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N2 - 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 studySetting: Aberdeen, ScotlandPopulation: 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=52443, twin=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 preeclampsia, 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 and delivering a singleton were at a higher risk of pre-eclampsia (adjusted risk ratios and 95% confidence intervals) (1.18, 1.02-1.37), antepartum haemorrhage (1.32, 1.18- 1.47), induction of labour (1.21, 1.11-1.31) and very preterm delivery (<32 weeks) (1.96, 1.53- 2.49). Subfertile women delivering twins were at a higher risk of being delivered by emergency caesarean section (2.14, 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.

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