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The association of adverse outcomes with pregnancy conception methods among low-risk term pregnancies

      Objective

      To compare composite neonatal and maternal adverse outcomes among low-risk singleton pregnancies at 37–41 weeks among conception methods: spontaneously-conceived (SC) pregnancy; infertility medications and/or intrauterine insemination (IFM/IUI); and assisted reproductive technology (ART).

      Design

      Population-based retrospective cohort study.

      Setting

      US Vital Statistics datasets 2013–2017.

      Patient(s)

      Low-risk pregnancies (without hypertensive disorders, pregestational or gestational diabetes, or history of preterm birth) of women ≥20 years with nonanomalous singletons, who labored, delivered at 37–41 weeks, and had data on pregnancy conception method.

      Intervention(s)

      None.

      Main Outcome Measure(s)

      The primary outcome was the composite neonatal adverse outcome (CNAO). The secondary outcome was the composite maternal adverse outcome (CMAO).

      Result(s)

      Of the 19.7 million deliveries during the study period, 54.0% (N = 10,676,184) met the inclusion criteria, with 99.0% (N = 10,573,741) being conceived spontaneously, 0.4% (N = 47,227) by IFM/IUI, and 0.5% (N = 55,216) by ART. The overall rate of CNAO was 6.68 per 1,000 live births. Compared with SC, the risk of CNAO was significantly higher among IFM/IUI (adjusted relative risk [aRR], 1.29; 95% CI, 1.18–1.41) and ART (aRR, 1.29; 95% CI, 1.18–1.39). The overall rate of CMAO was 2.50 per 1,000 live births. Compared with SC, the risk of CMAO was significantly increased among IFM/IUI (aRR, 1.72; 95% CI, 1.50–1.97) and ART (aRR, 2.40; 95% CI, 2.17–2.65).

      Conclusion(s)

      Among low-risk term singleton pregnancies, IFM/IUI and ART have modestly higher rates of adverse outcomes to maternal-neonatal dyad than SC.
      Asociación de resultados adversos con los métodos de concepción de la gestación en embarazos a término de bajo riesgo.

      Objetivo

      Comparar los resultados adversos neonatales y maternos combinados a las 37-41 semanas en gestaciones con feto único según los métodos de concepción: gestación concebida espontáneamente (SC); medicamentos para la infertilidad y/o inseminación intrauterina (IFM/IUI); y tecnología de reproducción asistida (ART).

      Diseño

      Estudio retrospectivo de cohorte basado en una población.

      Entorno

      Bases de datos de US Vital Statistics 2013-2017.

      Paciente(s)

      Embarazos de bajo riesgo (sin trastornos hipertensivos, diabetes pregestacional o gestacional o antecedentes de nacimiento pretérmino) de mujeres ≥ 20 años con hijos únicos no anómalos, con trabajo de parto a las 37-41 semanas y de las que existían datos sobre el método de concepción del embarazo.

      Intervención(es)

      Ninguna.

      Principales medidas de resultados

      La medida de resultado primaria fue el resultado adverso neonatal combinado (CNAO). La medida de resultado secundaria fue el resultado adverso materno combinado (CMAO).

      Resultado(s)

      De los 19,7 millones de partos durante el período de estudio, el 54,0% (N=10,676,184) cumplieron los criterios de inclusión, con el 99,0% (N=10,573,741) de concepción espontánea, 0,4% (N047,227) mediante IFM/IIU, y 0,5% (N=55,216) mediante ART. La tasa global de CNAO fue de 6,68 por 1,000 nacidos vivos. En comparación con SC, el riesgo de CNAO fue significativamente mayor entre IFM/IIU (riesgo relativo ajustado [aRR], 1,29; IC del 95%, 1.18-1.41) y ART (aRR, 1,29; IC del 95%, 1.18-1.39). La tasa general de CMAO fue de 2.50 por cada 1,000 nacidos vivos. En comparación con SC, el riesgo de CMAO aumentó significativamente entre IFM/IIU (aRR, 1,72; IC del 95%, 1.50–1.97) y ART (aRR, 2,40; IC del 95%, 2.17–2.65).

      Conclusión(es)

      Entre los embarazos de feto único a término de bajo riesgo, IFM/IIU y ART tienen tasas moderadamente más altas de resultados adversos para la díada materno-neonatal que SC.

      Key Words

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