The risk of preterm delivery is increased among patients who develop placental abruption after using assisted reproductive technology (ART), according to a recent study published in JAMA Network Open.1
Takeaways
- Patients using assisted reproductive technology (ART) have an increased risk of preterm delivery if they develop placental abruption.
- ART has been associated with multiple long-term health issues in children, including cardiometabolic risks such as altered glucose metabolism and elevated blood pressure.
- Data indicates an 83% higher risk of placental abruption in pregnancies conceived through ART compared to spontaneous conception.
- The study, based on data from the National Inpatient Sample, found that the overall adjusted odds ratio for preterm delivery among ART pregnancies versus spontaneous conceptions was 1.46.
- The study suggests that patients seeking infertility treatment should be counseled about the potential risks to their pregnancy, including the increased likelihood of preterm delivery associated with ART and placental abruption.
An increase in the use of ART for infertility treatment has been observed worldwide, with 413,776 ART cycles in the United States reported in 2021. Methods of ART include cryopreservation, in vitro fertilization, frozen embryo transfer cycles, intracytoplasmic sperm injection, and preimplantation genetic testing.
ART has been linked to multiple long-term morbidities in children.2 These include cardiometabolic risks such as altered glucose metabolism, elevated blood pressure, and suboptimal cardiac diastolic function. Altered body fat has also been reported in children born from ART.
Data has indicated an 83% increased risk of placental abruption from ART vs spontaneous conception.1 Additionally, abruption is linked to an increased risk of preterm delivery. Ischemic placental disease, which increases the risk of preterm delivery, has been indicated as more common in ART pregnancies.
Investigators conducted a population-based study to determine the impact of ART on the association between placental abruption and preterm delivery using data from the National Inpatient Sample. Relevant data included census division, rural vs urban location, hospital bed size, teaching status, and hospital ownership.1
Data was reported with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and (ICD-10-CM) codes. Participants included women aged 15 to 54 years with delivery between 2000 and 2019. Race and ethnicity were also reported, with categories including Black, Hispanic, White, and other.
Covariates included maternal age at delivery, hospital bed size, hospital location, hospital teaching status, region, race and ethnicity, plurality, insurance, income quartile, and year of delivery. Risks were reported based on race, plurality, age group, and income quartile for ART vs spontaneous conception.
There were 78,901,058 hospital deliveries reported from 2000 to 2019, 0.5% of which were conceived with ART. Patients were aged a mean 27.9 years and 11.7% were Black, 18.9% Hispanic, 44.2% White, and 25.2% other race or ethnicity. Of hospital deliveries, 98.2% were singleton, 68.8% vaginal, and 52.1% covered by private insurance.1
A 2-fold increased risk of placental abruption was observed in ART conceptions vs spontaneous conceptions, though this increased risk decreased over time. Overall placental abruption risks were 17 per 1000 births and 11 per 1000 births for ART and spontaneous conception, respectively.
An overall adjusted odds ratio (AOR) of 1.46 was reported for preterm delivery among ART pregnancies vs spontaneous conceptions. Rates of preterm delivery were 555 per 1000 births for ART and placental abruptions, 156 per 1000 for ART conception alone, and 421 per 1000 for placental abruption alone.1
Singleton pregnancies had a higher AOR for placental abruption at 1.46. Additional AORs for placental abruption included 1.63 for women aged 25 to 29 years and 1.62 for women with high incomes. Singleton pregnancies, patients aged 20 to 24 years, and medium to high incomes were linked to increased preterm delivery risk in women with ART conceptions.
These results indicated an increased risk of preterm delivery among patients with ART and placental abruption. Investigators recommending patients requesting infertility treatment receive counseling about risks to their pregnancy.1
Reference
- Zhang JT, Lee R, Sauer MV, Ananth CV. Risks of placental abruption and preterm delivery in patients undergoing assisted reproduction. JAMA Netw Open. 2024;7(7):e2420970. doi:10.1001/jamanetworkopen.2024.20970
- Pinborg A, Wennerholm U, Bergh C. Long-term outcomes for children conceived by assisted reproductive technology. Fertility and Sterility. 2023;120(3):449-456. doi:10.1016/j.fertnstert.2023.04.022
