Pregnant after assisted reproduction: a risk pregnancy is born! 18-years perinatal outcome results from a population-based registry in Flanders, Belgium

Keywords:

ART, assisted reproduction, ICSI, IUI, IVF, perinatal outcome, pregnancy, pregnancy outcome, singleton, twin.


Published online: Feb 12 2017

W. OMBELET1,2, G. MARTENS3, L. BRUCKERS

Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, Schiepse Bos 6, 3600 Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt, Belgium; SPE (Study Center for Perinatal Epidemiology), Brussels, Belgium; Center for Statistics (CENSTAT), Agoralaan building D, 3590 Diepenbeek, Belgium. 

Abstract

Background: Although the increased risk for perinatal morbidity and mortality of babies born after ART is largely attributed to a higher rate of multiple gestations, a signi cantly worse perinatal outcome for singleton pregnancies following A compared to pregnancies after natural conception has been reported as well. ost studies only include IVF/ICSI pregnancies; studies describing the perinatal outcome of pregnancies after non-IVF assisted reproduction are scarce.

Methods and Materials: opulation based cohort study with three e posure groups: a study group of pregnancies after ovarian stimulation S , with or without arti cial insemination AI , after IFV or ICSI and a naturally conceived C comparison group. ata from the regional registry of all hospital deliveries in the utch speaking part of Belgium during an years period from anuary until ecember were used. he perinatal outcome parameters were prematurity, low birth weight, perinatal mortality and morbidity including neonatal intracranial bleeding and need for intubation. ogistic regression analysis was used including mode of conception, female age, foetal se , parity and year of delivery.

Results: ata on births were studied: singletons IVF ICSI, S and C and twins IVF ICSI, S and C were available for analysis. IVF ICSI singletons had a signi cantly worse outcome when compared to S and C for almost all investigated perinatal parameters. on IVF S singletons were also signi cantly disadvantaged for prematurity and low birth weight when compared to C. he outcome of twin pregnancies was similar for the three groups unless only unlike se twins were studied separately. Among this subgroup, IVF ICSI carried a higher risk for low birth weight when compared to C. S unlike se twins were at increased risk for low birth weight, intra uterine death and perinatal mortality when compared to C.

Conclusion: According to our results all A pregnancies, whether due to IVF ICSI or non IVF treatment, have to be considered as risk pregnancies, irrespective of the number of foetuses.
Limitations of the study: Although our logistic regression analysis included co variables with a potential impact on perinatal outcome such as mode of conception, female age, foetal se , parity and year of delivery, we couldn t correct for other prominent confounders such as the use of fresh or frozen embryos, use of homologous or donor gametes, smoking, obesity, socio economic status, occupation e posures and pre e isting disease.