Newman Rachel A, Naqvi Mariam, Levian Candace, Smithson Sarah D, Esakoff Tania
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.
Loma Linda University Health, Loma Linda, California.
Am J Perinatol. 2024 Aug;41(11):1532-1537. doi: 10.1055/a-2157-3106. Epub 2023 Aug 21.
Among patients ≥45 years, the birth rate in the United States continues to increase. As fertility declines with age, this cohort often utilizes assisted reproductive technology, specifically in vitro fertilization (IVF). While both advancing maternal age and IVF are independently associated with adverse maternal outcomes, data regarding their additive effect are scant. This article aims to determine if patients who conceive via IVF are at increased risk for preterm birth (PTB) compared to patients with non-IVF pregnancies in a very advanced maternal age (vAMA) cohort (≥45 years).
Retrospective cohort study of all pregnant patients ≥45 years old who delivered at a single institution (2014-2021). Those with incomplete delivery/neonatal records or multiples beyond twins were excluded. We compared individuals who conceived via IVF to those who conceived without IVF. The primary outcome was preterm delivery <37 weeks gestation. Secondary outcomes included other adverse perinatal outcomes. Using multivariable logistic regression, we adjusted for multiple gestation as well as confounders found to be significantly different in the univariable analysis and other known risk factors for PTB.
In our study cohort of 420 vAMA patients, individuals who underwent IVF were more likely to be older, privately insured, nulliparous, and with a twin gestation. The PTB rate in vAMA patients who underwent IVF was 24.4 compared to 8.4% in patients who did not use IVF ( < 0.001). After adjusting for confounders, IVF was an independent risk factor for PTB <37 weeks in vAMA patients (adjusted odds ratio {aOR] = 4.3, 95% confidence interval [CI]: 1.7-10.4, = 0.001). In vitro fertilization was also associated with a composite of adverse maternal outcomes (hypertensive disorder of pregnancy, postpartum hemorrhage, blood transfusion, and unplanned hysterectomy) (aOR = 1.7, 95% CI: [1.1-2.9], = 0.03).
In the vAMA population, conception via IVF is associated with an increased risk of PTB <37 weeks.
· This study examines IVF as an independent risk factor for PTB in patients ≥45 years at delivery, which has not been specifically addressed in prior studies.. · In vAMA patients, use of IVF is associated with an increased risk of PTB <37 weeks. These patients also have higher rates of cesarean delivery. Neonates from IVF pregnancies are more likely to be very low birth weight or low birth weight.. · Bodies of research exist for both advanced maternal age and assisted reproductive technology, there is a paucity of data specifically in parturients of vAMA who conceive via IVF..
在美国，45岁及以上患者的生育率持续上升。随着生育能力随年龄下降，这一人群常采用辅助生殖技术，特别是体外受精（IVF）。虽然母亲年龄增长和IVF都与不良妊娠结局独立相关，但关于它们的叠加效应的数据却很少。本文旨在确定在高龄产妇（vAMA，≥45岁）队列中，与非IVF妊娠的患者相比，通过IVF受孕的患者早产（PTB）风险是否增加。
对在单一机构分娩的所有45岁及以上孕妇进行回顾性队列研究（2014 - 2021年）。排除分娩/新生儿记录不完整或三胎及以上多胎妊娠的患者。我们将通过IVF受孕的个体与未通过IVF受孕的个体进行比较。主要结局是妊娠<37周的早产。次要结局包括其他不良围产期结局。使用多变量逻辑回归，我们对多胎妊娠以及在单变量分析中发现有显著差异的混杂因素和其他已知的PTB风险因素进行了校正。
在我们420例vAMA患者的研究队列中，接受IVF的个体年龄更大、有私人保险、未生育且为双胎妊娠的可能性更大。接受IVF的vAMA患者的PTB发生率为24.4%，而未使用IVF的患者为8.4%（<0.001）。校正混杂因素后，IVF是vAMA患者妊娠<37周时PTB的独立危险因素（校正比值比[aOR]=4.3，95%置信区间[CI]：1.7 - 10.4，P = 0.001）。体外受精还与一系列不良妊娠结局（妊娠高血压疾病、产后出血、输血和计划外子宫切除术）相关（aOR = 1.7，95% CI：[1.1 - 2.9]，P = 0.03）。
在vAMA人群中，通过IVF受孕与妊娠<37周时PTB风险增加相关。
· 本研究将IVF作为分娩时年龄≥45岁患者PTB的独立危险因素进行研究，此前研究未专门涉及这一点。· 在vAMA患者中，使用IVF与妊娠<37周时PTB风险增加相关。这些患者剖宫产率也更高。IVF妊娠的新生儿极低出生体重或低出生体重的可能性更大。· 关于高龄产妇和辅助生殖技术都有相关研究，但专门针对通过IVF受孕的vAMA产妇的数据较少。
