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.
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 language | English |
|---|---|
| Pages (from-to) | 1320-1328 |
| Number of pages | 9 |
| Journal | BJOG-An International Journal of Obstetrics and Gynaecology |
| Volume | 123 |
| Issue number | 8 |
| Early online date | 2 Sept 2015 |
| DOIs | |
| Publication status | Published - Jul 2016 |
Bibliographical note
FundingNo 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.
Keywords
- cohort study
- obstetric outcomes
- pregnancy complications
- subfertility