MedicalResearch.com Interview with:
Natalie Dayan MD MSc FRCPC
General Internal Medicine and Obstetric Medicine,
Clinician-Scientist, Research Institute
Centre for Outcomes Research and Evaluation (CORE)
McGill University Health Centre
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Infertility treatment is rising in use and has been linked with maternal and perinatal complications in pregnancy, but the extent to which it is associated with severe maternal morbidity (SMM), a composite outcome of public health importance, has been less well studied. In addition, whether the effect is due to treatment or to maternal factors is unclear.
We conducted a propensity matched cohort study in Ontario between 2006 and 2012. We included 11 546 women who had an infertility-treated pregnancy and a singleton live or stillborn delivery beyond 20 weeks. Each woman exposed to infertility treatment was then matched using a propensity score to approximately 5 untreated pregnancies (n=47 553) in order to address confounding by indication. Poisson regression revealed on overall 40% increase in the risk of a composite of SMM (one of 44 previously validated indicators using ICD-10CA codes and CCI procedure codes) (30.3 per 1000 births vs. 22.8 per 1000 births, adjusted relative risk 1.39, 95% CI 1.23-1.56). When stratified according to invasive (eg., IVF) and non-invasive treatments (eg. IUI or pharmacological ovulation induction), women who were treated with IVF had an elevated risk of having any severe maternal morbidity, and of having 3 or more SMM indicators (adjusted odds ratio 2.28, 95% CI 1.56 – 3.33), when compared with untreated women, whereas women who were treated with non-invasive treatments had no increase in these risks.
MedicalResearch.com: What should readers take away from your report?
Response: While the absolute risk difference is low, it appears that assisted pregnancy, especially by IVF, carries a heightened risk of severe maternal morbidity. Furthermore, women pregnant by IVF are more likely to have 3 or more indicators of morbidity. Our study suggests that at least part of the effect is due to the treatment itself, but which aspect(s) of treatment is unclear.
Women should be counseled about these potential health risks prior to treatment and efforts should be made to optimize maternal health pre-treatment. Treatment plans should be selected based on a woman’s risk for poor outcomes as well as her chances of success. Some women pregnant by IVF may benefit from closer surveillance in pregnancy and a heightened awareness of potential risks.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We think there are two important areas of research to pursue based on this study:
(1) to develop a prediction tool to predict a woman’s risk of a severe complication before pregnancy in order to aid decision making with her reproductive care provider, and
(2) evaluate the mechanism of this increased risk so that treatments can be further modified to reduce risk as much as possible.
MedicalResearch.com: Is there anything else you would like to add?
Response: American studies have recently shown similar findings, although some were unable to distinguish different types of infertility treatment or did not examine the number of SMM indicators according to treatment status.
Disclosures: This study was led by researchers at ICES, Research Institute of the McGill University Health Centre (RI-MUHC) and St. Michael’s Hospital and was funded bythe Canadian Institutes of Health Research.
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