Risk of poor neonatal outcome at term after medically assisted reproduction: A propensity score-matched study

Sabine Ensing*, Ameen Abu-Hanna, Tessa J. Roseboom, Sjoerd Repping, Fulco Van Der Veen, Ben Willem J. Mol, Anita C.J. Ravelli

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

Objective To study risk of birth asphyxia and related morbidity among term singletons born after medically assisted reproduction (MAR). Design Population cohort study. Setting Not applicable. Patient(s) A total of 1,953,932 term singleton pregnancies selected from a national registry for 1999-2011. Intervention(s) None. Main Outcome Measure(s) Primary outcome Apgar score <4; secondary outcomes Apgar score <7, intrauterine fetal death, perinatal mortality, congenital anomalies, small for gestational age, asphyxia related morbidity, and cesarean delivery. Result(s) The risks of birth asphyxia and related morbidity were calculated in women who conceived either through MAR or spontaneously (SC), with a subgroup analysis for in vitro fertilization (IVF). An additional propensity score matching analysis was performed with matching on multiple maternal baseline covariates (maternal age, ethnicity, socioeconomic status, parity, year of birth, and preexistent diseases). Each MAR pregnancy was matched to three SC controls. Relative to SC, the MAR singletons had an increased risk of adverse neonatal outcomes including Apgar score <4 (adjusted odds ratio [OR] 1.29; 95% CI, 1.14-1.46) and intrauterine fetal death (adjusted OR 1.61; 95% CI, 1.35-1.91). After propensity score matching, the risk of an Apgar score <4 was comparable between MAR and SC singletons (OR 0.99; 95% CI, 0.87-1.14). Cesarean delivery for both fetal distress and nonprogressive labor occurred more among MAR pregnancies compared with SC pregnancies. Conclusion(s) Term singletons conceived after MAR have an increased risk of morbidity related to birth asphyxia. Because this is mainly due to maternal characteristics, obstetric caregivers should be aware that the increased rates of cesareans reflect the behavior of women and physicians rather than increased perinatal complications.

Original languageEnglish
Pages (from-to)384-390.e1
JournalFertility and Sterility
Volume104
Issue number2
DOIs
Publication statusPublished - 1 Aug 2015

Keywords

  • Birth asphyxia
  • in vitro fertilization
  • medically assisted reproduction (MAR)
  • poor neonatal outcome
  • propensity score matching

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