Risk factors vary early preterm birth and perinatal complications after assisted reproductive technology

Objective. Assisted reproductive technology (ART)-treated women exhibit increased risk of premature delivery compared to fertile women. We evaluated whether ART treatment modalities increase prematurity and whether placental abnormalities and pregnancy-induced hypertensive (PIH) disorders mediate these risks. Method(s): This retrospective study of ART-treated and fertile deliveries (2004–2017) used an ART-cycle database linked to Massachusetts birth certificates and hospital discharges. Outcomes of late preterm birth (LPTB: 34–36 weeks gestation) and early preterm birth (EPTB: <34 weeks gestation) were compared with term deliveries (≥37 weeks gestation) in ART-treated (linked to the ART database) and fertile (no indicators of infertility or ART) deliveries. ART treatments with autologous oocyte, donor oocyte, fresh or frozen embryo transfer (FET), intracytoplasmic sperm injection (ICSI) and no-ICSI were separately compared to the fertile group. Adjusted odds ratios (AOR) were calculated with multivariable logistic regression: placental abnormalities or PIH were quantified in the pathway as mediators. Results: There were 218,320 deliveries: 204,438 fertile and 13,882 ART-treated. All treatment types increased prematurity (AOR 1.31–1.58, LPTB; AOR 1.34–1.48, EPTB). Placental abnormalities mediated in approximately 22% and 38% of the association with LPTB and EPTB, respectively. PIH mediated 25% and 33% of the association with LPTB and EPTB in FET and donor oocyte cycles, more than other treatments (<10% LPTB and <13% EPTB). Conclusions: ART-treatment and all ART modalities increased LPTB and EPTB when compared with fertile deliveries. Placental abnormalities modestly mediated associations approximately equally, while PIH was a stronger mediator in FET and donor oocyte cycles. Reasons for differences require exploration.

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Prevention of Preterm Birth

Journal of Biomedical and Clinical Research ◽

10.2478/jbcr-2018-0013 ◽

2018 ◽

Vol 11 (2) ◽

pp. 95-104

Author(s):

Ivan D. Ivanov ◽

Stefan A. Buzalov ◽

Nadezhda H. Hinkova

Keyword(s):

Risk Factors ◽

Preterm Birth ◽

High Risk ◽

Medical Science ◽

Secondary Prophylaxis ◽

High Risk Group ◽

Screening Methods ◽

Perinatal Complications ◽

Social Significance ◽

Neonatal Deaths

Summary Preterm birth (PTB) is a worldwide problem with great social significance because it is a leading cause of perinatal complications and perinatal mortality. PTB is responsible for more than a half of neonatal deaths. The rate of preterm delivery varies between 5-18% worldwide and has not decreased in recent years, regardless of the development of medical science. One of the leading causes for that is the failure to identify the high-risk group in prenatal care. PTB is a heterogeneous syndrome in which many different factors interfere at different levels of the pathogenesis of the initiation of delivery, finally resulting in delivery before 37 weeks of gestation (wg). The various specificities of risk factors and the unclear mechanism of initiation of labour make it difficult to elaborate standard, unified and effective screening to diagnose pregnant women at high-risk for PTB correctly. Furthermore, they make primary and secondary prophylaxis less effective and render diagnostic and therapeutic measures ineffective and inappropriate. Reliable and accessible screening methods are necessary for antenatal care, and risk factors for PTB should be studied and clarified in search of useful tools to solve issues of risk pregnancies to decrease PTB rates and associated complications.

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Endometrial endotoxin, assisted reproductive technology, and preterm birth

Fertility and Sterility ◽

10.1016/j.fertnstert.2004.04.036 ◽

2004 ◽

Vol 82 (4) ◽

pp. 793-794

Author(s):

J IAMS

Keyword(s):

Preterm Birth ◽

Assisted Reproductive Technology ◽

Reproductive Technology

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A Clinical Nomogram For Predicting Preterm Birth in Women Who Conceived Through Assisted Reproductive Technology

10.21203/rs.3.rs-1036505/v1 ◽

2021 ◽

Author(s):

Yaduan Lin ◽

Fanchen He ◽

Rui Gao ◽

Ting Liu ◽

Ke Zhao ◽

...

Keyword(s):

Preterm Birth ◽

Assisted Reproductive Technology ◽

Risk Model ◽

Cox Regression ◽

Early Stage ◽

Statistical Significance ◽

Reproductive Technology ◽

Brier Score ◽

Chronic Hypertension ◽

Singleton Pregnancy

Abstract Background: We used prepregnant and gestational characteristics as predictors to develop and validated a nomogram predicting the risk of preterm birth (PTB) in assisted reproductive technology (ART) treated women. Methods: The National Vital Statistics System (NVSS) was queried for singleton ART-treated pregnant women from 2015 to 2019. Multivariable cox regression was used to develop the early (< 32 weeks) or late (< 37 weeks) PTB risk model using both statistical significance and clinical importance criteria for variable selection. The predictive accuracy was assessed, and bootstrapping was used for validation. A nomogram was constructed for the presentation of the final model. Results: ART-treated women who were over 45 years old, black, obese, had a history of cesarean section and PTB, restarting ART within 3 months, prepregnant diabetes, chronic hypertension, gestational diabetes, gestational hypertension, and eclampsia, had the highest risk for late and early-stage PTB. The nomogram with these variables accurately predicted PTB in ART women with a singleton pregnancy. (Brier score:0.121, calibration slope: 0.99, c-index: 0.684). Conclusion: We created a nomogram predicting the risk of early or late PTB in ART women with a singleton pregnancy, which could identify potentially at-risk women who seeking ART treatment and inform appropriate preterm care.

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