Department of Healthcare Management, Eulji University, Seongnam, Republic of Korea.
Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
PLoS One. 2022 Oct 10;17(10):e0275857. doi: 10.1371/journal.pone.0275857. eCollection 2022.
Whether infertility treatment predicts severe maternal morbidity in both singleton and twin pregnancies is controversial. We conducted this nationwide population-based cohort study to compare pregnancies conceived through assisted reproductive technology treatments, such as intrauterine insemination or in vitro fertilization, with unassisted pregnancies.
This study included 269,930 women who experienced childbirth in 2018, using data of the National Health Insurance Service National Delivery Cohort in Korea. The primary outcome was assessed using a severe maternal morbidity algorithm developed by the Centers for Disease Control and Prevention in the United States. A modified Poisson regression was used to estimate the adjusted risk ratio of severe maternal morbidity.
Severe maternal morbidity occurred in 6,333 (2.3%) of 280,612 deliveries investigated. The risk of severe maternal morbidity was approximately 1.5-fold higher among women who received in vitro fertilization (risk ratio: 1.51, 95% confidence interval: 1.36-1.68) than among fertile women. However, no significant association between intrauterine insemination and maternal morbidity was identified. Via subgroup analysis, in vitro fertilization increased the risk of severe maternal morbidity by 1.6- and 1.3-fold in singleton and multiple births, respectively (singleton: risk ratio: 1.62, 95% confidence interval: 1.43-1.83; multiple birth: risk ratio: 1.31, 95% confidence interval: 1.07-1.60).
This study suggested that in vitro fertilization was associated with the risk of severe maternal morbidity in both singleton and multiple births. Further research should identify patient- and treatment-specific factors that may mitigate or prevent adverse maternal health risks.
不孕治疗是否会预测单胎和双胎妊娠的严重产妇发病率尚存在争议。我们进行了这项全国性基于人群的队列研究，比较了通过辅助生殖技术治疗（如宫腔内人工授精或体外受精）受孕的妊娠与未经辅助的妊娠。
本研究纳入了 2018 年分娩的 269930 名女性，数据来源于韩国国家健康保险服务国家分娩队列。主要结局使用美国疾病控制与预防中心开发的严重产妇发病率算法进行评估。采用修正泊松回归估计严重产妇发病率的调整风险比。
在 280612 次分娩中，6333 例（2.3%）发生严重产妇发病率。与生育能力正常的女性相比，接受体外受精的女性严重产妇发病率风险约高 1.5 倍（风险比：1.51，95%置信区间：1.36-1.68）。然而，宫腔内人工授精与产妇发病率之间无显著相关性。通过亚组分析，体外受精分别使单胎和多胎妊娠发生严重产妇发病率的风险增加 1.6 倍和 1.3 倍（单胎：风险比：1.62，95%置信区间：1.43-1.83；多胎：风险比：1.31，95%置信区间：1.07-1.60）。
本研究表明，体外受精与单胎和多胎妊娠的严重产妇发病率风险相关。进一步的研究应确定可能减轻或预防不良产妇健康风险的患者和治疗特异性因素。
