Severe Maternal Morbidity and Maternal Mortality Associated with Assisted Reproductive Technology

Area of Science:

• Reproductive Medicine
• Maternal Health
• Obstetrics

Background:

• Assisted reproductive technologies (ART) are increasingly used globally.
• Understanding the risks of severe maternal morbidity (SMM) associated with ART is crucial for patient counseling and clinical management.

Purpose of the Study:

• To evaluate the association between ART utilization and the incidence of severe maternal morbidity and mortality (SMM).

Main Methods:

• A cohort study analyzed hospital delivery data in Canada (excluding Québec) from April 2009 to March 2018.
• Inclusion criteria: deliveries at ≥20 weeks gestation.
• Statistical analysis involved multivariable regression to calculate rate ratios (RR) and adjusted rate ratios (aRR) with 95% confidence intervals (CI).

Main Results:

• The study included over 2.5 million deliveries, with 2.8% involving ART.
• ART use was linked to a 3-fold increased risk of composite SMM (RR 3.01) compared to non-ART pregnancies.
• Specific SMM types, including severe preeclampsia, HELLP syndrome, eclampsia, severe hemorrhage, and acute renal failure, showed significantly higher rates in the ART group.
• Adjusted analysis confirmed an elevated risk (aRR 2.34), and multi-fetal ART pregnancies had a 4.7 times higher SMM rate than singleton non-ART pregnancies.

Conclusions:

• Deliveries following ART are associated with substantially increased risks of severe maternal morbidity.
• Healthcare providers should counsel patients on these elevated risks, emphasizing the comparatively lower risks in ART-conceived singleton pregnancies.