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Q&A

Obstetric Quality and Safety

Poster Session 4

(1008) Risk of Severe Maternal Morbidity among Pregnancies resulting from Infertility Treatment

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

As infertility rates rise in the US, more women are seeking infertility treatment. Though there is much to gain from infertility treatments (IT), there are well-documented risks associated with resulting pregnancies. Despite the rising number of IT pregnancies, data on the relationship between IT and severe maternal morbidity (SMM) are limited.

Study Design:

Retrospective population-based cohort study of all singleton US live births using vital statistics birth certificate records, 2014-2019. Demographic, medical, and pregnancy factors were compared between pregnancies resulting from infertility treatment and those not. The primary outcome was composite SMM, defined as maternal ICU admission, eclampsia, blood transfusion, unplanned hysterectomy, or ruptured uterus. Multivariate logistic regression estimated the relative influence of infertility treatment on SMM risk in pregnancies after adjustment for co-existing risks.

Results:

Of 22,568,980 singleton live births, 299,069 (1.8%) resulted from IT. Composite SMM rate was 0.70% in pregnancies without IT, and 2-fold higher (1.4%) among those with IT, adjRR 2.02 (95%CI 1.96, 2.09). IT was also associated with significantly increased risk of all individual measures of SMM, even after adjusting for confounding variables (figure). IT pregnancies resulting specifically from fertility enhancing drugs (FED) had 60% increased risk of composite SMM, adjRR 1.62 (95%CI 1.53, 1.71) and those with assisted reproductive technology (ART) had 50% increased risk, adjRR1.51 (95%CI 1.22, 1.89) compared to pregnancies without IT. Unplanned hysterectomy and blood transfusion risks were over 3-fold increased with ART, adjRR 3.25 (95% CI 2.89, 3.65) and adjRR 3.43 (95% CI 3.26, 3.61), respectively.

Conclusion:

Pregnancies achieved following infertility treatment in the US are associated with significantly increased risk of SMM. These findings may inform counseling on pregnancy risks among those seeking fertility treatment and decisions regarding acuity level of care access for prenatal care and delivery planning.