Victory Jenna, John Sid, Wang Li Qing, Koegl Johanna, Richter Lindsay L, Bayrampour Hamideh, Joseph K S, Lisonkova Sarka
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (Victory, John, Wang, Richter, Joseph, and Lisonkova).
Women's Health Research Institute, Vancouver, BC, Canada (Victory, Wang, Joseph, and Lisonkova).
AJOG Glob Rep. 2024 Jun 19;4(3):100367. doi: 10.1016/j.xagr.2024.100367. eCollection 2024 Aug.
In vitro fertilization (IVF) as a fertility treatment is associated with adverse perinatal outcomes. Racial/ethnic disparity in severe maternal morbidity (SMM) in women who conceived by IVF is understudied.
To examine differences in the association between race/ethnicity and SMM between women who conceived spontaneously and those who conceived using IVF.
We included all singleton live births and stillbirths in the United States, 2016-2021; data were obtained from the National Center for Health Statistics. Maternal race/ethnicity included non-Hispanic White (NHW), non-Hispanic Black (NHB), American Indian and Alaska Native (AIAN), Asian, Pacific Islander (PI), Hispanic, and mixed-race categories. The SMM composite outcome included eclampsia, uterine rupture, peripartum hysterectomy, blood transfusion, and intensive care unit (ICU) admission. We used logistic regression to adjust for potential confounders (such as age, education, parity, prepregnancy body mass index, smoking during pregnancy, chronic hypertension, and preexisting diabetes) and to assess modification of the association between race/ethnicity and SMM by IVF.
The study population included 21,585,015 women: 52% were NHW, 15% NHB, 0.8% AIAN, 6% Asian, 0.2% PI, 24% Hispanic, and 2% were of mixed race. IVF was used by 183,662 (0.85%) women; the rate of the SMM composite outcome was 18.5 per 1000 deliveries and 7.9 per 1000 deliveries in the IVF and spontaneous conception groups, respectively (unadjusted rate ratio 2.34, 95% confidence interval [CI] 2.26-2.43). In women with spontaneous conception, NHB, Asian and mixed-race women had elevated odds of SMM compared with NHW women (adjusted odds ratio [aOR]=1.39, 95% CI 1.37-1.41; aOR=1.04, 95% CI 1.02-1.07; and aOR=1.42, 95% CI 1.38-1.46, respectively). Racial/ethnic disparities in SMM and its components were not different between the IVF and spontaneous conception groups for the mixed-race category. NHB and Hispanic women had significantly higher aORs for uterine rupture/intrapartum hysterectomy compared with NHW women in the IVF group, while Asian women had a higher aOR for ICU admission compared with NHW women in the IVF group.
Women who conceived by IVF have a greater than two-fold higher risk of SMM and this higher risk is evident across all racial/ethnic groups. However, NHB and Hispanic women who conceived by IVF had a higher risk of uterine rupture/hysterectomy, and Asian women who conceived by IVF had a higher risk of ICU admission. Our results warrant further investigation examining pregnancy and postpartum care issues among racial/ethnic minority women who conceive using IVF.
体外受精（IVF）作为一种生育治疗方法，与不良围产期结局相关。对于通过IVF受孕的女性，严重孕产妇发病率（SMM）方面的种族/民族差异研究不足。
探讨自然受孕女性与接受IVF受孕女性在种族/民族与SMM关联方面的差异。
我们纳入了2016 - 2021年美国所有单胎活产和死产病例；数据来自国家卫生统计中心。孕产妇种族/民族包括非西班牙裔白人（NHW）、非西班牙裔黑人（NHB）、美国印第安人和阿拉斯加原住民（AIAN）、亚裔、太平洋岛民（PI）、西班牙裔以及混血种族类别。SMM综合结局包括子痫、子宫破裂、产后子宫切除术、输血以及重症监护病房（ICU）入院。我们使用逻辑回归来调整潜在混杂因素（如年龄、教育程度、产次、孕前体重指数、孕期吸烟、慢性高血压和既往糖尿病），并评估IVF对种族/民族与SMM关联的影响。
研究人群包括21,585,015名女性：52%为NHW，15%为NHB，0.8%为AIAN，6%为亚裔，0.2%为PI，24%为西班牙裔，2%为混血种族。183,662名（0.85%）女性使用了IVF；IVF组和自然受孕组SMM综合结局的发生率分别为每1000例分娩18.5例和每1000例分娩7.9例（未调整的率比为2.34，95%置信区间[CI] 2.26 - 2.43）。在自然受孕的女性中，NHB、亚裔和混血种族女性发生SMM的几率高于NHW女性（调整后的优势比[aOR]=1.39，95% CI 1.37 - 1.41；aOR=1.04，95% CI 1.02 - 1.07；aOR=1.42，95% CI 1.38 - 1.46）。对于混血种族类别，IVF组和自然受孕组在SMM及其组成部分方面的种族/民族差异无差异。在IVF组中，NHB和西班牙裔女性子宫破裂/产时子宫切除术的aOR显著高于NHW女性，而亚裔女性在IVF组中ICU入院的aOR高于NHW女性。
通过IVF受孕的女性发生SMM的风险高出两倍多，且这种较高风险在所有种族/民族群体中都很明显。然而，通过IVF受孕的NHB和西班牙裔女性子宫破裂/子宫切除术的风险较高，通过IVF受孕的亚裔女性ICU入院的风险较高。我们的结果值得进一步研究，以探讨接受IVF受孕的种族/民族少数群体女性的妊娠和产后护理问题。
