Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2019

Open Access 01-12-2019 | Premature Birth | Research article

Singleton pregnancies after in vitro fertilization in Estonia: a register-based study of complications and adverse outcomes in relation to the maternal socio-demographic background

Authors: Kaja Rahu, Kärt Allvee, Helle Karro, Mati Rahu

Published in: BMC Pregnancy and Childbirth | Issue 1/2019

Login to get access

Abstract

Background

An increased risk of adverse conditions related to in vitro fertilization (IVF) pregnancies has been repeatedly reported. Our study aimed to summarize outcome differences between pregnancies after IVF and after spontaneous conception (SC) in Estonia.

Methods

Data on all liveborn singletons to primiparas women aged 25–40 years during the period 2005–2014 were obtained from the Estonian Medical Birth Registry. There were 1778 and 33,555 newborns in the IVF and SC cohort, respectively. The relative risk of pregnancy-related complications and adverse pregnancy outcomes in the IVF cohort in comparison with the SC cohort was quantified by prevalence proportion ratios (RR) with 95% confidence intervals (CI) using modified Poisson regression models adjusted for maternal age, education, ethnicity, marital status and study period.

Results

The cohort of IVF singletons experienced a higher risk of preterm birth (RR 1.51; 95% CI 1.28–1.78), iatrogenic preterm birth (RR 1.62; 95% CI 1.32–1.98), very preterm birth (RR 1.49; 95% CI 1.00–2.23), low birthweight (RR 1.47; 95% CI 1.20–1.80), congenital anomalies (RR 1.51; 95% CI 1.08–2.11), and admission to a neonatal intensive care unit (RR 1.13; 95% CI 1.01–1.26). Somewhat elevated risk of spontaneous preterm birth did not reach statistical significance (RR 1.32; 95% CI 0.97–1.80). IVF mothers were at increased risk of placenta previa (RR 7.15; 95% CI 4.04–12.66), placental abruption (RR 2.12; 1.43–3.14) and cesarean section (RR 1.28; 95% CI 1.20–1.37). The risk of pre-eclampsia was borderline (RR 1.25; 95% CI 0.98–1.59). Adjustment for maternal age attenuated the associations between IVF and adverse outcomes. Maternal education, ethnicity and marital status had no effect on the magnitude of the risk estimates.

Conclusions

The increased risk of pregnancy-related complications and adverse pregnancy outcomes was observed in the Estonian cohort of IVF singletons in comparison with the cohort of SC singletons. The relative risk estimates grew with maternal age but were not influenced by the maternal education, ethnicity and marital status. To monitor the efficacy and safety of the used assisted reproductive technology, a specialized country-wide register should be created in Estonia.
Literature
1.
2.
Lai T, Habicht T, Kahur K, Reinap M, Kiivet R, van Ginneken E. Estonia: health system review. Health Syst Transit. 2013;15:1–196.PubMed
3.
De Geyter C, Calhaz-Jorge C, Kupka MS, Wyns C, Mocanu E, Motrenko T, et al. ART in Europe, 2014: results generated from European registers by ESHRE. Hum Reprod. 2018;33:1586–601.CrossRef
4.
Steptoe PC, Edwards RG. Birth after the reimplantation of a human embryo. Lancet. 1978;2:366.CrossRef
5.
Klemetti R, Sevón T, Gissler M, Hemminki E. Health of children born as a result of in vitro fertilization. Pediatrics. 2006;118:1819–27.CrossRef
6.
Kalra SK, Barnhart KT. In vitro fertilization and adverse childhood outcomes: what we know, where we are going, and how we will get there. A glimpse into what lies behind and beckons ahead. Fertil Steril. 2011;95:1887–9.CrossRef
7.
Sullivan-Pyke CS, Senapati S, Mainigi MA, Barnhart KT. In vitro fertilization and adverse obstetric and perinatal outcomes. Semin Perinatol. 2017;41:345–53.CrossRef
8.
McDonald SD, Han Z, Mulla S, Murphy KE, Beyene J, Ohlsson A. Preterm birth and low birth weight among in vitro fertilization singletons: a systematic review and meta-analyses. Eur J Obstet Gynecol Reprod Biol. 2009;146:138–48.CrossRef
9.
Pandey S, Shetty A, Hamilton M, Bhattacharya S, Maheshwari A. Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis. Hum Reprod Update. 2012;18:485–503.CrossRef
10.
Pinborg A, Wennerholm UB, Romundstad LB, Loft A, Aittomaki K, Söderström-Anttila V, et al. Why do singletons conceived after assisted reproduction technology have adverse perinatal outcome? Systematic review and meta-analysis. Hum Reprod Update. 2013;19:87–104.CrossRef
11.
Qin J, Liu X, Sheng X, Wang H, Gao S. Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies. Fertil Steril. 2016;105:73–85.CrossRef
12.
Poikkeus P, Gissler M, Unkila-Kallio L, Hyden-Granskog C, Tiitinen A. Obstetric and neonatal outcome after single embryo transfer. Hum Reprod. 2007;22:1073–9.CrossRef
13.
Sazonova A, Källen K, Thurin-Kjellberg A, Wennerholm UB, Bergh C. Obstetric outcome after in vitro fertilization with single or double embryo transfer. Hum Reprod. 2011;26:442–50.CrossRef
14.
Martin AS, Chang J, Zhang Y, Kawwass JF, Boulet SL, McKane P, et al. Perinatal outcomes among singletons after assisted reproductive technology with single-embryo or double-embryo transfer versus no assisted reproductive technology. Fertil Steril. 2017;107:954–60.CrossRef
15.
Pelkonen S, Koivunen R, Gissler M, Nuojua-Huttunen S, Suikkari AM, Hydén-Granskog C, et al. Perinatal outcome of children born after frozen and fresh embryo transfer: the Finnish cohort study 1995–2006. Hum Reprod. 2010;25:914–23.CrossRef
16.
Sazonova A, Källen K, Thurin-Kjellberg A, Wennerholm UB, Bergh C. Obstetric outcome in singletons after in vitro fertilization with cryopreserved/thawed embryos. Hum Reprod. 2012;27(5):1343–50.CrossRef
17.
Wennerholm UB, Henningsen AK, Romundstad LB, Bergh C, Pinborg A, Skjaerven R, et al. Perinatal outcomes of children born after frozen-thawed embryo transfer: a Nordic cohort study from the CoNARTaS group. Hum Reprod. 2013;28:2545–53.CrossRef
18.
Marino JL, Moore VM, Willson KJ, Rumbold A, Whitrow MJ, Giles LC, et al. Perinatal outcomes by mode of assisted conception and sub-fertility in an Australian data linkage cohort. PLoS One. 2014;9:e80398.CrossRef
19.
Qin J, Sheng X, Wu D, Gao S, You Y, Yang T, et al. Adverse obstetric outcomes associated with in vitro fertilization in singleton pregnancies: a prospective cohort study. Reprod Sci. 2017;24:595–608.CrossRef
20.
Seggers J, Pontesilli M, Ravelli ACJ, Painter RC, Hadders-Algra M, Heineman MJ, et al. Effects of in vitro fertilization and maternal characteristics on perinatal outcomes: a population-based study using siblings. Fertil Steril. 2016;105:590–8.e2.CrossRef
21.
Räisänen S, Randell K, Nielsen HS, Gissler M, Kramer MR, Klemetti R, et al. Socioeconomic status affects the prevalence, but not the perinatal outcomes, of in vitro fertilization pregnancies. Hum Reprod. 2013;28:3118–25.CrossRef
22.
Koupilova I, Rahu K, Rahu M, Karro H, Leon DA. Social determinants of birthweight and length of gestation in Estonia during the transition to democracy. Int J Epidemiol. 2000;29:118–24.CrossRef
23.
Allvee K, Rahu M, Haldre K, Karro H, Rahu K. Quality of IVF status registration in the Estonian medical birth registry: a national record linkage study. Reprod Health. 2018;15:133.CrossRef
24.
Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, et al. The international glossary on infertility and fertility care, 2017. Hum Reprod. 2017;32:1786–801.CrossRef
25.
Vorobjov S, Rahu M, Rahu K, Karro H. Eesti Meditsiinilise Sünniregistri andmete kvaliteet. [The data quality in the Estonian Medical Birth Registry]. Eesti Arst. 2008;87:608–14 (in Estonian).
26.
Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159:702–6.CrossRef
27.
Allvee K, Karro H, Rahu K. Üksikrasedusest sündinud IVF-lapsed Eestis: võimalikud tervisemõjurid, perinataalsurmarisk ja emade sotsiaal-demograafiline taust [Singleton IVF children in Estonia: possible health determinants, perinatal mortality risk and maternal socio-demographic background.]. Eesti Arst. 2014;93:133–41 (in Estonian).
28.
Henningsen AA, Gissler M, Skjaerven R, Bergh C, Tiitinen A, Romundstad LB, et al. Trends in perinatal health after assisted reproduction: a Nordic study from the CoNARTaS group. Hum Reprod. 2015;30:710–6.CrossRef
29.
Fujii M, Matsuoka R, Bergel E, van der Poel S, Okai T. Perinatal risk in singleton pregnancies after in vitro fertilization. Fertil Steril. 2010;94:2113–7.CrossRef
30.
Cavoretto P, Candiani M, Giorgione V, Inversetti A, Abu-Saba MM, Tiberio F, et al. Risk of spontaneous preterm birth in singleton pregnancies conceived after IVF/ICSI treatment: meta-analysis of cohort studies. Ultrasound Obstet Gynecol. 2018;51:43–53.CrossRef
31.
Joseph KS, Fahey J, Shankardass K, Allen VM, O’Campo P, Dodds L, et al. Effects of socioeconomic position and clinical risk factors on spontaneous and iatrogenic preterm birth. BMC Pregnancy Childbirth. 2014;14:117.CrossRef
32.
Hayashi M, Nakai A, Satoh S, Matsuda Y. Adverse obstetric and perinatal outcomes of singleton pregnancies may be related to maternal factors associated with infertility rather than the type of assisted reproductive technology procedure used. Fertil Steril. 2012;98:922–8.CrossRef
33.
Neumann K, Cirkel C, Rody A, Beyer DA. Do ART patients face higher C-section rates during their stage of delivery? A German monocenter experience. Arch Gynecol Obstet. 2017;295:481–5.CrossRef
34.
Räisänen S, Gissler M, Kramer MR, Heinonen S. Influence of delivery characteristics and socioeconomic status on giving birth by caesarean section – a cross sectional study during 2000–2010 in Finland. BMC Pregnancy Childbirth. 2014;14:120.CrossRef
35.
Romundstad LB, Romundstad PR, Sunde A, von Düring V, Skjaerven R, Vatten LJ. Increased risk of placenta previa in pregnancies following IVF/ICSI; a comparison of ART and non-ART pregnancies in the same mother. Hum Reprod. 2006;21:2353–8.CrossRef
36.
Hansen M, Kurinczuk JJ, Milne E, de Klerk N, Bower C. Assisted reproductive technology and birth defects: a systematic review and meta-analysis. Hum Reprod Update. 2013;19:330–53.CrossRef
37.
Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braveman PA. Socioeconomic disparities in adverse birth outcomes: a systematic review. Am J Prev Med. 2010;39:263–72.CrossRef
38.
39.
Cantarutti A, Franchi M, Monzio Compagnoni M, Merlino L, Corrao G. Mother's education and the risk of several neonatal outcomes: an evidence from an Italian population-based study. BMC Pregnancy Childbirth. 2017;17:221.CrossRef
40.
Rossi BV, Abusief M, Missmer SA. Modifiable risk factors and infertility: what are the connections? Am J Lifestyle Med. 2014;10:220–31.CrossRef
41.
Luke B. Adverse effects of female obesity and interaction with race on reproductive potential. Fertil Steril. 2017;107:868–77.CrossRef
42.
Pärna K, Rahu M, Youngman LD, Rahu K, Nygård-Kibur M, Koupil I. Self-reported and serum cotinine-validated smoking in pregnant women in Estonia. Matern Child Health J. 2005;9:385–92.CrossRef
43.
44.
Allvee K, Karro H. Estonian Medical Birth Registry 1992–2015. Estonian Abortion Registry 1996–2015. Compendium. Tallinn: NIHD; 2016.
45.
Luke B, Brown MB. Elevated risks of pregnancy complications and adverse outcomes with increasing maternal age. Hum Reprod. 2007;22:1264–72.CrossRef
46.
Klemetti R, Gissler M, Sainio S, Hemminki E. Associations of maternal age with maternity care use and birth outcomes in primiparous women: a comparison of results in 1991 and 2008 in Finland. BJOG. 2014;121:356–62.CrossRef
47.
Klemetti R, Gissler M, Sainio S, Hemminki E. At what age does the risk for adverse maternal and infant outcomes increase? Nationwide register-based study on first births in Finland in 2005–2014. Acta Obstet Gynecol Scand. 2016;95:1368–75.CrossRef
48.
Waldenström U. Postponing parenthood to advanced age. Ups J Med Sci. 2016;121:235–43.CrossRef
49.
Giorgione V, Parazzini F, Fesslova V, Cipriani S, Candiani M, Inversetti A, et al. Congenital heart defects in IVF/ICSI pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018;51:33–42.CrossRef
Metadata
Title
Singleton pregnancies after in vitro fertilization in Estonia: a register-based study of complications and adverse outcomes in relation to the maternal socio-demographic background
Authors
Kaja Rahu
Kärt Allvee
Helle Karro
Mati Rahu
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2019
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-019-2194-x

Other articles of this Issue 1/2019

BMC Pregnancy and Childbirth 1/2019 Go to the issue

Research article

Risk of adverse pregnancy outcomes and seroprevalence for brucellosis in pregnant women exposed to goats or raw goat products in southern Thailand: a prospective cohort study

Research article

Mode of birth after caesarean section: individual prediction scores using Scottish population data

Research article

Fetal weight estimation at term – ultrasound versus clinical examination with Leopold’s manoeuvres: a prospective blinded observational study

Research article

Male partner antenatal clinic attendance is associated with increased uptake of maternal health services and infant BCG immunization: a national survey in Kenya

Research article

Factors associated with low birthweight among newborns delivered at public health facilities of Nekemte town, West Ethiopia: a case control study

Research article

Non-additive effects of ACVR2A in preeclampsia in a Philippine population