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The association of adverse outcomes with pregnancy conception methods among low-risk term pregnancies
Morgen S Doty1, Han-Yang Chen1, Stephen M Wagner1
1Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas.
Objective:
To compare composite neonatal and maternal adverse outcomes among low-risk singleton pregnancies at 37-41 weeks among conception methods: spontaneously-conceived (SC) pregnancy; infertility medications and/or intrauterine insemination (IFM/IUI); and assisted reproductive technology (ART).
Design:
Population-based retrospective cohort study.
Setting:
US Vital Statistics datasets 2013-2017.
Patient(S):
Low-risk pregnancies (without hypertensive disorders, pregestational or gestational diabetes, or history of preterm birth) of women ≥20 years with nonanomalous singletons, who labored, delivered at 37-41 weeks, and had data on pregnancy conception method.
Intervention(S):
None.
Main Outcome Measure(S):
The primary outcome was the composite neonatal adverse outcome (CNAO). The secondary outcome was the composite maternal adverse outcome (CMAO).
Result(S):
Of the 19.7 million deliveries during the study period, 54.0% (N = 10,676,184) met the inclusion criteria, with 99.0% (N = 10,573,741) being conceived spontaneously, 0.4% (N = 47,227) by IFM/IUI, and 0.5% (N = 55,216) by ART. The overall rate of CNAO was 6.68 per 1,000 live births. Compared with SC, the risk of CNAO was significantly higher among IFM/IUI (adjusted relative risk [aRR], 1.29; 95% CI, 1.18-1.41) and ART (aRR, 1.29; 95% CI, 1.18-1.39). The overall rate of CMAO was 2.50 per 1,000 live births. Compared with SC, the risk of CMAO was significantly increased among IFM/IUI (aRR, 1.72; 95% CI, 1.50-1.97) and ART (aRR, 2.40; 95% CI, 2.17-2.65).
Conclusion(S):
Among low-risk term singleton pregnancies, IFM/IUI and ART have modestly higher rates of adverse outcomes to maternal-neonatal dyad than SC.
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