Severe Maternal Morbidity and the Use of Assisted Reproductive Technology in Massachusetts.
Severe Maternal Morbidity and the Use of Assisted Reproductive Technology in Massachusetts.
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DOI：
10.1097/aog.0000000000001292
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发表时间：
2016-03
影响因子：
7.2
通讯作者：
Stern JE
中科院分区：
文献类型：
--
作者：
Belanoff C;Declercq ER;Diop H;Gopal D;Kotelchuck M;Luke B;Nguyen T;Stern JE
评估使用辅助生殖技术（ART）、有生育能力低下指标但没有辅助生殖技术（“生育能力低下”）和既没有辅助生殖技术也没有生育能力低下（“生育能力”）的妇女分娩时严重孕产妇发病率的风险是否存在差异。这项回顾性队列研究是马萨诸塞州辅助生殖技术结果研究（MOSART）的一部分。为了构建MOSART数据库并识别ART分娩，我们将ART治疗记录与2004年至2010年间马萨诸塞州的出生证明和母婴住院记录联系起来。一种ICD-9-CM诊断算法和程序代码确定了严重的孕产妇发病率。我们使用Logistic广义估计方程来估计与生育状况相关的严重孕产妇发病率的几率，调整了孕产妇人口统计学和健康因素以及胎龄，并对多胞胎和分娩方式进行了分层。该人群中严重孕产妇发病率（n = 458,918）为1.16%。总体而言，孕产期、低孕产期和抗逆转录病毒治疗分娩中严重孕产妇发病率的粗患病率分别为1.09%、1.44%和3.14%。严重产妇发病率的最常见指标是输血。在多变量分析中，在单胎中，与生育（阴道：aOR 2.27, 95% CI: 1.78 - 2.88；剖宫产：aOR 1.67, 95% CI: 1.40 - 1.98）和次生育（阴道：aOR 1.97, 95% CI: 1.30 - 3.00；剖宫产：aOR 1.75, 95% CI: 1.30 - 2.35）分娩相比，ART与严重产妇发病率增加相关。在双胞胎中，只有剖宫产ART分娩比剖宫产生育有更严重的产妇发病率（aOR 1.48, 95% CI: 1.14, 1.93）。通过抗逆转录病毒治疗怀孕的妇女在分娩时可能有较高的严重孕产妇发病风险，主要表现为输血，即使与低生育能力人群相比也是如此。进一步的研究应该阐明这种风险背后的机制。
To assess whether risk of severe maternal morbidity at delivery differed for women who conceived using assisted reproductive technology (ART), those with indicators of subfertility but no ART (“subfertile”), and those who had neither ART nor subfertility (“fertile”). This retrospective cohort study was part of the larger Massachusetts Outcomes Study of Assisted Reproductive Technology (MOSART). To construct the MOSART database and identify ART deliveries, we linked ART treatment records to birth certificates and maternal and infant hospitalization records occurring in Massachusetts between 2004 and 2010. An algorithm of ICD-9-CM diagnosis and procedure codes identified severe maternal morbidity. We used Logistic Generalized Estimating Equations to estimate odds of severe maternal morbidity associated with fertility status, adjusting for maternal demographic and health factors and gestational age, stratifying on plurality and method of delivery. The prevalence of severe maternal morbidity among this population (n = 458,918) was 1.16%. The overall, crude prevalences of severe maternal morbidity among fertile, subfertile and ART deliveries were 1.09%, 1.44% and 3.14%, respectively. The most common indicator of severe maternal morbidity was blood transfusion. In multivariable analyses, among singletons, ART was associated with increased odds of severe maternal morbidity compared to both fertile (Vaginal: aOR 2.27, 95% CI: 1.78 – 2.88; cesarean: aOR 1.67, 95% CI: 1.40 – 1.98, respectively) and subfertile (vaginal: aOR 1.97, 95% CI: 1.30 – 3.00; cesarean: aOR 1.75, 95% CI: 1.30 – 2.35, respectively) deliveries. Among twins, only cesarean ART deliveries had significantly greater severe maternal morbidity compared to cesarean fertile deliveries (aOR 1.48, 95% CI: 1.14, 1.93). Women who conceive through ART may have elevated risk severe maternal morbidity at delivery, largely indicated by blood transfusion, even when compared with a subfertile population. Further research should elucidate mechanisms underlying this risk.