Assisted reproductive technology and the risk of pregnancy related complications and adverse pregnancy outcomes in singleton pregnancies A meta analysis of cohort studies

Capsule:
This study aimed to determine whether there are any increases in pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies after assisted reproductive technology compared with those conceived naturally.

Authors:
Jiabi Qin, M.D., Ph.D., Xiaoying Liu, M.D., Xiaoqi Sheng, M.D., Hua Wang, M.D., Shiyou Gao, M.D.

Volume 105, Issue 1, Pages 73-85

Abstract:

Objective:
To determine whether there are any increases in pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies after assisted reproductive technology (ART) compared with those conceived naturally.

Design:
Meta-analysis.

Setting:
University-affiliated teaching hospital.

Patient(s):
Singleton pregnancies conceived with ART and naturally.

Intervention(s):
PubMed, Google Scholar, Cochrane Libraries and Chinese database were searched through March 2015 to identify studies that met pre-stated inclusion criteria. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates. Subgroup analysis was performed to explore potential heterogeneity moderators.

Main Outcome Measure(s):
Pregnancy-related complications and adverse pregnancy outcomes.

Result(s):
Fifty cohort studies comprising 161,370 ART and 2,280,241 spontaneously conceived singleton pregnancies were identified. The ART singleton pregnancies had a significantly increased risk of pregnancy-induced hypertension (relative risk [RR] 1.30, 95% confidence interval [CI] 1.04–1.62; I2 = 79%), gestational diabetes mellitus (RR 1.31, 95% CI 1.13–1.53; I2 = 6%), placenta previa (RR 3.71, 95% CI 2.67–5.16; I2 = 72%), placental abruption (RR 1.83, 95% CI 1.49–2.24; I2 = 22%), antepartum hemorrhage (RR 2.11, 95% CI 1.86–2.38; I2 = 47%), postpartum hemorrhage (RR 1.29, 95% CI 1.06–1.57; I2 = 65%), polyhydramnios (RR 1.74, 95% CI 1.24–2.45; I2 = 0%), oligohydramnios (RR 2.14, 95% CI 1.53–3.01; I2 = 0%), cesarean sections (RR 1.58, 95% CI 1.48–1.70; I2 = 92%), preterm birth (RR 1.71, 95% CI 1.59–1.83; I2=80%), very preterm birth (RR 2.12, 95% CI 1.73–2.59; I2 = 90%), low birth weight (RR 1.61, 95% CI 1.49–1.75; I2 = 80%), very low birth weight (RR 2.12, 95% CI 1.84–2.43; I2 = 67%), small for gestational age (RR 1.35, 95% CI 1.20–1.52; I2 = 82%), perinatal mortality (RR 1.64, 95% CI 1.41–1.90; I2=45%), and congenital malformation (RR 1.37, 95% CI 1.29–1.45; I2=41%). Relevant heterogeneity moderators have been identified by subgroup analysis. Sensitivity analysis yielded consistent results. No evidence of publication bias was observed.

Conclusion(s):
The ART singleton pregnancies are associated with higher risks of adverse obstetric outcomes. Obstetricians should manage these pregnancies as high risk.

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