- The risk for severe maternal morbidity or death was modestly increased among women whose pregnancy was achieved by infertility treatment, especially in vitro fertilisation.
- Women undergoing non-invasive infertility treatment, such as intrauterine insemination, were not at increased risk.
Why this matters
- Although infertility treatment improves the chances of pregnancy among infertile couples, there is no clarity if women who conceived using infertility treatment have more indicators of severe maternal morbidity.
- Cohort study used data from population-based registries (Ontario) between 2006 and 2012.
- Pregnancies achieved by fertility treatment (n=11,546; invasive: n=5974 and non-invasive treatment: n=5572) were compared with unassisted pregnancies (n=47,553) using propensity score matching.
- Primary outcome: occurrence of composite severe morbidity or mortality between 20 weeks' gestation and 42 days postpartum.
- Funding: Canadian Institutes of Health Research.
- Severe maternal morbidity or death occurred in 356 pregnancies resulting from infertility treatment (30.8 per 1000 deliveries) vs 1054 untreated pregnancies (22.2 per 1000 deliveries) (adjusted relative risk [aRR], 1.39; 95% CI, 1.23-1.56).
- Compared with untreated pregnancies, severe maternal morbidity or death occurred in 121 pregnancies achieved through non-invasive treatment (21.7 per 1000 deliveries; aRR, 0.98; 95% CI, 0.81-1.18) and in 235 pregnancies through invasive treatment (39.3 per 1000 deliveries, aRR, 1.77; 95% CI, 1.54-2.03).
- The odds of having 3 or more indicators of severe maternal morbidity were higher among women who used infertility treatment (aOR, 2.28; 95% CI, 1.56-3.33).
- No association was seen for non-invasive infertility treatment (aOR, 0.99; 95% CI, 0.57-1.72).
- Possible non-differential misclassification of exposure.