Obstetric outcome in women with subfertility

Obstetrics and Gynaecology, University of Aberdeen, Aberdeen, Scotland, United Kingdom
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.86). 05/2005; 112(5):632-7. DOI: 10.1111/j.1471-0528.2004.00489.x
Source: PubMed

ABSTRACT It has been suggested that a history of subfertility is associated with increased obstetric and perinatal risks. It is unclear if the cause is inherent characteristics in the women or the fertility treatment.
To compare the obstetric and perinatal risks of singleton pregnancies in women with a history of subfertility in comparison with the general population.
Population cohort.
Aberdeen, Scotland.
Cases were women attending the Fertility Clinic between 1989 and 1999 who subsequently went on to have singleton pregnancies. Controls included the general population of women who delivered singletons over the same period.
We performed a retrospective cohort study to investigate the obstetric outcome of singleton pregnancies in women with subfertility. The general population of women who delivered singletons over the same period served as controls.
Obstetric and perinatal complications in singleton pregnancies.
Maternity records were available for a total of 1437 subfertile women and 21,688 controls. Subfertile women were older [mean (SD) age: 31 (4.7) years vs 27 (5.4) years, P < 0.01] and more likely to be primiparous (70% vs 65%, P < 0.001). After adjusting for age and parity, subfertile women were at increased risk of pre-eclampsia (OR 1.9, 95% CI 1.5-2.5), placenta praevia (OR 3.9, 95% CI 2.2-7.0) and placental abruption (OR 1.8, 95% CI 1.1-3.0), and more likely to undergo induction of labour (OR 1.5, 95% CI 1.3-1.6), caesarean section (OR 2.1, 95% CI 1.8-2.4) and instrumental delivery (OR 2.2, 95% CI 1.8-2.6), and deliver low birthweight (OR 1.4, 95% CI 1.3-1.7) and preterm (OR 1.7, 95% CI 1.2-2.2) infants. There were no differences between treatment-related and treatment-independent pregnancies.
Subfertile women are at higher risk of obstetric complications, which persist after adjusting for age and parity.

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    • "The reason for the differences in the obstetric outcomes in spontaneous pregnancies and pregnancies with either fresh or frozen embryo transfers is unclear. Several factors related to the reproductive laboratory technology itself (De Geyter et al., 2006; Ombelet et al., 2006; Shih et al., 2008; Pelinck et al., 2010a,b; Nelissen et al., 2012; Makinen et al., 2013) or the patient characteristics (Thomson et al., 2005; Romundstad et al., 2008) may be involved. One of the factors possibly affecting pregnancy outcomes is COH, which causes a supraphysiologic endocrine uterine environment and suboptimal endometrial development (Hansen et al., 2002; Chung et al., 2006; Kalra et al., 2011; Kansal Kalra et al., 2011), which may finally result in adverse obstetric outcomes (Hansen et al., 2002; Chung et al., 2006; De Geyter et al., 2006; Ombelet et al., 2006; Wennerholm et al., 2009; Pelinck et al., 2010a,b). "
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    Human Reproduction 09/2014; 29(11). DOI:10.1093/humrep/deu223 · 4.59 Impact Factor
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    • "On sait que l'infertilité est en elle-même un facteur de risque de complications obsté tricales telles que les accouchement pré maturé s (Odd ratio [OR] = 1,38 [1,25–1,54]), le retard de croissance intra-uté rin (RCIU) (OR = 1,24 [1,16–1,45]), le petit poids de naissance (Odd ratio ajusté [aOR] = 1,4 [1,1–1,7]), la pré e ´ clampsie (aOR = 1,9 [1,4–2,5]), le placenta praevia (aOR = 3,9 [2,2–7,0]) ou encore le dé collement placentaire (aOR = 1,8 [1,1–3,0]) [9] [10] [11]. Il semble e ´ galement y avoir une augmentation significative des risques d'induction du travail (aOR = 1,5 [1,3–1,6]), d'extraction instrumentale (aOR = 2,2 [1,8–2,6]) et de cé sarienne (aOR = 2,1 [1,8–2,4]) [10] [11]. Il est lé gitime de se demander si l'endomé triose est un facteur de risque surajouté de complications obsté tricales. "
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    Gynécologie Obstétrique & Fertilité 03/2014; · 0.58 Impact Factor
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    • "In addition, infertile women are known to have an increased prevalence of cardiovascular disease (Parikh et al., 2012), depression (Wilkins et al., 2010) and certain types of reproductive cancers, such as uterine cancer (Brinton et al., 2005). Investigations into perinatal effects of subfertility have revealed that compared with the general population, spontaneously conceiving subfertile women are at risk for hypertension, pre-eclampsia, antepartum hemorrhage and other labor complications, as well as bearing infants preterm or with LBWs (Thomson et al., 2005; Jaques et al., 2010). Additionally, one study revealed that the prevalence of congenital malformation is positively correlated with increased time to pregnancy (Zhu et al., 2006). "
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