马萨诸塞州的严重孕产妇发病率与辅助生殖技术的使用

Severe Maternal Morbidity and the Use of Assisted Reproductive Technology in Massachusetts.

作者信息

Belanoff Candice, Declercq Eugene R, Diop Hafsatou, Gopal Daksha, Kotelchuck Milton, Luke Barbara, Nguyen Thien, Stern Judy E

机构信息

Department of Community Health Sciences, Boston University School of Public Health, the Massachusetts Department of Public Health, and Massachusetts General Hospital, Center for Child & Adolescent Health Research and Policy, Harvard Medical School, Boston, Massachusetts; the Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan; and the Department of Obstetrics & Gynecology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.

出版信息

Obstet Gynecol. 2016 Mar;127(3):527-534. doi: 10.1097/AOG.0000000000001292.

DOI:10.1097/AOG.0000000000001292

PMID:26855105

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4764424/

Abstract

OBJECTIVE

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").

METHODS

This retrospective cohort study was part of the larger Massachusetts Outcomes Study of Assisted Reproductive Technology. To construct the Massachusetts Outcomes Study of Assisted Reproductive Technology 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 International Classification of Diseases, 9th Revision, Clinical Modification 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.

RESULTS

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 with both fertile (vaginal: adjusted odds ratio [OR] 2.27, 95% confidence interval [CI] 1.78-2.88; cesarean: adjusted OR 1.67, 95% CI 1.40-1.98, respectively) and subfertile (vaginal: adjusted OR 1.97, 95% CI 1.30-3.00; cesarean: adjusted OR 1.75, 95% CI 1.30-2.35, respectively) deliveries. Among twins, only cesarean ART deliveries had significantly greater severe maternal morbidity compared with cesarean fertile deliveries (adjusted OR 1.48, 95% CI 1.14-1.93).

CONCLUSION

Women who conceive through ART may have elevated risk of 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.

摘要

目的

评估采用辅助生殖技术（ART）受孕的女性、有亚生育指标但未采用ART的女性（“亚生育女性”）以及既未采用ART也无亚生育情况的女性（“生育力正常女性”）在分娩时发生严重孕产妇发病的风险是否存在差异。

方法

这项回顾性队列研究是规模更大的马萨诸塞州辅助生殖技术结局研究的一部分。为构建马萨诸塞州辅助生殖技术结局研究数据库并识别ART分娩情况，我们将ART治疗记录与2004年至2010年期间马萨诸塞州的出生证明以及母婴住院记录相链接。采用国际疾病分类第九版临床修订本诊断和程序编码算法来确定严重孕产妇发病情况。我们使用逻辑广义估计方程来估计与生育状况相关的严重孕产妇发病几率，并对孕产妇人口统计学和健康因素以及孕周进行调整，按分娩的胎次和方式进行分层。

结果

该人群（n = 458,918）中严重孕产妇发病的患病率为1.16%。生育力正常女性、亚生育女性和ART分娩女性中严重孕产妇发病的总体粗患病率分别为1.09%、1.44%和3.14%。严重孕产妇发病最常见的指标是输血。在多变量分析中，对于单胎分娩，与生育力正常女性（阴道分娩：调整后的优势比[OR]为2.27，95%置信区间[CI]为1.78 - 2.88；剖宫产：调整后的OR为1.67，95% CI为1.40 - 1.98）和亚生育女性（阴道分娩：调整后的OR为1.97，95% CI为1.30 - 3.00；剖宫产：调整后的OR为1.75，95% CI为1.30 - 2.35）相比，ART与严重孕产妇发病几率增加相关。对于双胎分娩，只有ART剖宫产分娩与生育力正常女性剖宫产分娩相比，严重孕产妇发病显著更高（调整后的OR为1.48，95% CI为1.14 - 1.93）。