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. 2019 Feb 20;19(1):77.
doi: 10.1186/s12884-019-2213-y.

Complications and adverse outcomes in pregnancy and childbirth among women who conceived by assisted reproductive technologies: a nationwide birth cohort study of Japan environment and children's study

Chie Nagata  1   2 , Limin Yang  2 , Kiwako Yamamoto-Hanada  2 , Hidetoshi Mezawa  2 , Tadayuki Ayabe  2 , Kazue Ishizuka  2 , Mizuho Konishi  2 , Yukihiro Ohya  2   3 , Hirohisa Saito  2   4 , Haruhiko Sago  5   6 ; Japan Environment & Children’s Study Group
Collaborators, Affiliations

Complications and adverse outcomes in pregnancy and childbirth among women who conceived by assisted reproductive technologies: a nationwide birth cohort study of Japan environment and children's study

Chie Nagata et al. BMC Pregnancy Childbirth. .

Abstract

Background: Although pregnancies conceived by assisted reproductive technology (ART) have a higher risk of maternal/perinatal complications, the overall risk of adverse outcomes necessitating advanced obstetric care has not been closely examined. The present study aimed to assess and compare the risk of maternal/perinatal complications and adverse outcomes in pregnancy and childbirth conceived by ART with those conceived naturally.

Methods: This study was conducted as a part of the Japan environment and children's study (JECS), an ongoing nationwide birth cohort study in Japan. The risk of maternal/perinatal complications and adverse outcomes was assessed by mode of conception (natural conception, ovulation induction [OI] without ART, conventional in vitro fertilization and embryo transfer [IVF-ET], or intracytoplasmic sperm injection [ICSI]) using logistic regression and generalized estimating equations controlling for potential confounders.

Results: The final dataset included women who conceived naturally (N = 90,506), by OI without ART (N = 3939), by conventional IVF-ET (N = 1476), and by ICSI (N = 1671). Compared with women who conceived naturally, those who conceived by conventional IVF-ET were at higher risk of placenta previa (adjusted OR 2.90 [95% CI 1.94, 4.34]), morbidly adherent placenta (6.85 [3.88, 12.13]), and pregnancy-induced hypertension (1.40 [1.10, 1.78]) whereas those who conceived by ICSI had a higher risk of placental abruption (2.16 [1.20, 3.88]) as well as placenta previa (2.01 [1.29, 3.13]) and morbidly adherent placenta (7.81 [4.56, 13.38]). Women who conceived by ART had a higher risk of blood transfusion (conventional IVF-ET: 3.85 [2.52, 5.88]; ICSI: 3.76 [2.49, 5.66]) and ICU admission (conventional IVF-ET: 2.58 [1.11, 6.01]; ICSI: 3.45 [1.68, 7.06]) even after controlling for potential confounders. Neonates conceived by ART had a higher risk of preterm birth (conventional IVF-ET: 1.42 [1.13, 1.78]; ICSI: 1.31 [1.05, 1.64]).

Conclusions: Women who conceived by ART had a higher risk of maternal/perinatal complications necessitating advanced obstetric care. Obstetricians should be aware of the increased risk of adverse outcomes among this population.

Keywords: ART; Assisted reproductive technology; Blood transfusion; ICSI; IVF; In vitro fertilization; Intensive care unit; Intracytoplasmic sperm injections; Ovulation induction; Placental diseases.

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Conflict of interest statement

Ethics approval and consent to participate

JECS was approved by the institutional review board on epidemiological studies of the Ministry of the Environment and the ethics committees of all the participating institutions (i.e., NIES, NCCHD, Hokkaido University, Sapporo Medical University, Asahikawa Medical College, Japanese Red Cross Hokkaido College of Nursing, Tohoku University, Fukushima Medical University, Chiba University, Yokohama City University, University of Yamanashi, Shinshu University, University of Toyama, Nagoya City University, Kyoto University, Doshisha University, Osaka University, Osaka Medical Center and Research Institute for Maternal and Child Health, Hyogo College of Medicine, Tottori University, Kochi University, University of Occupational and Environmental Health, Kyushu University, Kumamoto University, University of Miyazaki, and University of the Ryukyus). JECS is being conducted in accordance with the Declaration of Helsinki and other relevant regulations in the country. Written informed consent was obtained from all participants. The present study was conducted as a part of JECS and used anonymized data; hence, additional approval from the ethics committee was not required.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow chart of participants in the analysis
See this image and copyright information in PMC

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