Maternal Morbidity and Medically Assisted Reproduction Treatment Types

Area of Science:

• Reproductive Medicine
• Maternal Health
• Obstetrics

Background:

• Medically assisted reproduction (MAR) encompasses various treatments to overcome infertility.
• Understanding the maternal morbidity risks associated with different MAR methods is crucial for patient counseling and care.
• Previous studies have suggested a link between MAR and adverse maternal outcomes, but specific risks by treatment type require further investigation.

Purpose of the Study:

• To compare the odds of maternal morbidity across different modes of conception, specifically comparing fertility-enhancing drugs, intrauterine insemination (IUI), and assisted reproductive technology (ART) with autologous or donor oocytes against unassisted pregnancies.
• To investigate whether the invasiveness of MAR treatments correlates with the risk of maternal morbidity.
• To identify factors that may mediate or confound the relationship between MAR and maternal morbidity.

Main Methods:

• A retrospective cohort study utilizing Utah birth certificate data from 2009-2017 (N=469,919 deliveries).
• Maternal morbidity was defined as the presence of severe complications including blood transfusion, unplanned surgery, ICU admission, eclampsia, hysterectomy, or uterine rupture.
• Logistic regression models were employed to assess the association between MAR (overall and by treatment type) and maternal morbidity, with adjustments for sociodemographics, pre-existing conditions, multifetal gestation, and obstetric comorbidities.

Main Results:

• Pregnancies conceived via MAR exhibited higher odds of maternal morbidity, with risk increasing with treatment invasiveness.
• Associations were partially explained by multifetal gestation and obstetric comorbidities.
• Assisted reproductive technology (ART) with autologous oocytes remained associated with higher morbidity (OR 1.46). However, in singleton births, differences in morbidity between MAR groups and unassisted pregnancies were not statistically significant after controlling for obstetric comorbidities.

Conclusions:

• More invasive MAR treatments, including ART and IUI, are associated with increased maternal morbidity.
• Less invasive MAR treatments did not show a significant association with higher maternal morbidity.
• While multifetal gestation and obstetric comorbidities partially explain the observed associations, subfertility itself may be an independent contributor to maternal morbidity.