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

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. Meta-analysis. University-affiliated teaching hospital. Singleton pregnancies...

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Bibliographic Details
Published inFertility and sterility Vol. 105; no. 1; pp. 73 - 85.e6
Main Authors Qin, Jiabi, Liu, Xiaoying, Sheng, Xiaoqi, Wang, Hua, Gao, Shiyou
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.01.2016
Subjects
Adverse pregnancy outcomes
assisted reproductive technology
Chi-Square Distribution
Female
Fertility
Humans
Infertility - diagnosis
Infertility - physiopathology
Infertility - therapy
Internal Medicine
Linear Models
meta-analysis
Obstetrics and Gynecology
Odds Ratio
Pregnancy
Pregnancy Complications - diagnosis
Pregnancy Complications - etiology
pregnancy-related complications
Reproductive Techniques, Assisted - adverse effects
Risk Assessment
Risk Factors
singleton pregnancies
meta-analysis
assisted reproductive technology
pregnancy-related complications
Adverse pregnancy outcomes
singleton pregnancies
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Abstract 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. Meta-analysis. University-affiliated teaching hospital. Singleton pregnancies conceived with ART and naturally. 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. Pregnancy-related complications and adverse pregnancy outcomes. 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. The ART singleton pregnancies are associated with higher risks of adverse obstetric outcomes. Obstetricians should manage these pregnancies as high risk.
AbstractList 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. Meta-analysis. University-affiliated teaching hospital. Singleton pregnancies conceived with ART and naturally. 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. Pregnancy-related complications and adverse pregnancy outcomes. 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; I(2) = 79%), gestational diabetes mellitus (RR 1.31, 95% CI 1.13-1.53; I(2) = 6%), placenta previa (RR 3.71, 95% CI 2.67-5.16; I(2) = 72%), placental abruption (RR 1.83, 95% CI 1.49-2.24; I(2) = 22%), antepartum hemorrhage (RR 2.11, 95% CI 1.86-2.38; I(2) = 47%), postpartum hemorrhage (RR 1.29, 95% CI 1.06-1.57; I(2) = 65%), polyhydramnios (RR 1.74, 95% CI 1.24-2.45; I(2) = 0%), oligohydramnios (RR 2.14, 95% CI 1.53-3.01; I(2) = 0%), cesarean sections (RR 1.58, 95% CI 1.48-1.70; I(2) = 92%), preterm birth (RR 1.71, 95% CI 1.59-1.83; I(2)=80%), very preterm birth (RR 2.12, 95% CI 1.73-2.59; I(2) = 90%), low birth weight (RR 1.61, 95% CI 1.49-1.75; I(2) = 80%), very low birth weight (RR 2.12, 95% CI 1.84-2.43; I(2) = 67%), small for gestational age (RR 1.35, 95% CI 1.20-1.52; I(2) = 82%), perinatal mortality (RR 1.64, 95% CI 1.41-1.90; I(2)=45%), and congenital malformation (RR 1.37, 95% CI 1.29-1.45; I(2)=41%). Relevant heterogeneity moderators have been identified by subgroup analysis. Sensitivity analysis yielded consistent results. No evidence of publication bias was observed. The ART singleton pregnancies are associated with higher risks of adverse obstetric outcomes. Obstetricians should manage these pregnancies as high risk.
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. Meta-analysis. University-affiliated teaching hospital. Singleton pregnancies conceived with ART and naturally. 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. Pregnancy-related complications and adverse pregnancy outcomes. 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. The ART singleton pregnancies are associated with higher risks of adverse obstetric outcomes. Obstetricians should manage these pregnancies as high risk.
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.
OBJECTIVETo 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.DESIGNMeta-analysis.SETTINGUniversity-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; I(2) = 79%), gestational diabetes mellitus (RR 1.31, 95% CI 1.13-1.53; I(2) = 6%), placenta previa (RR 3.71, 95% CI 2.67-5.16; I(2) = 72%), placental abruption (RR 1.83, 95% CI 1.49-2.24; I(2) = 22%), antepartum hemorrhage (RR 2.11, 95% CI 1.86-2.38; I(2) = 47%), postpartum hemorrhage (RR 1.29, 95% CI 1.06-1.57; I(2) = 65%), polyhydramnios (RR 1.74, 95% CI 1.24-2.45; I(2) = 0%), oligohydramnios (RR 2.14, 95% CI 1.53-3.01; I(2) = 0%), cesarean sections (RR 1.58, 95% CI 1.48-1.70; I(2) = 92%), preterm birth (RR 1.71, 95% CI 1.59-1.83; I(2)=80%), very preterm birth (RR 2.12, 95% CI 1.73-2.59; I(2) = 90%), low birth weight (RR 1.61, 95% CI 1.49-1.75; I(2) = 80%), very low birth weight (RR 2.12, 95% CI 1.84-2.43; I(2) = 67%), small for gestational age (RR 1.35, 95% CI 1.20-1.52; I(2) = 82%), perinatal mortality (RR 1.64, 95% CI 1.41-1.90; I(2)=45%), and congenital malformation (RR 1.37, 95% CI 1.29-1.45; I(2)=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.
Author Liu, Xiaoying
Gao, Shiyou
Wang, Hua
Sheng, Xiaoqi
Qin, Jiabi
Author_xml – sequence: 1
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  surname: Qin
  fullname: Qin, Jiabi
  email: qinjiabi123@hotmail.com
  organization: Division of Medical Genetics, Maternal and Child Health Hospital of Hunan Province, Hunan, People's Republic of China
– sequence: 2
  givenname: Xiaoying
  surname: Liu
  fullname: Liu, Xiaoying
  organization: Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Hunan, People's Republic of China
– sequence: 3
  givenname: Xiaoqi
  surname: Sheng
  fullname: Sheng, Xiaoqi
  organization: Division of Medical Genetics, Maternal and Child Health Hospital of Hunan Province, Hunan, People's Republic of China
– sequence: 4
  givenname: Hua
  surname: Wang
  fullname: Wang, Hua
  organization: Division of Medical Genetics, Maternal and Child Health Hospital of Hunan Province, Hunan, People's Republic of China
– sequence: 5
  givenname: Shiyou
  surname: Gao
  fullname: Gao, Shiyou
  organization: Reproductive Center, Maternal and Child Health Hospital of Hunan Province, Hunan, People's Republic of China
BackLink https://www.ncbi.nlm.nih.gov/pubmed/26453266$$D View this record in MEDLINE/PubMed
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Keywords meta-analysis
assisted reproductive technology
pregnancy-related complications
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Snippet To determine whether there are any increases in pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies after assisted...
Objective To determine whether there are any increases in pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies after...
OBJECTIVETo determine whether there are any increases in pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies after assisted...
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StartPage 73
SubjectTerms Adverse pregnancy outcomes
assisted reproductive technology
Chi-Square Distribution
Female
Fertility
Humans
Infertility - diagnosis
Infertility - physiopathology
Infertility - therapy
Internal Medicine
Linear Models
meta-analysis
Obstetrics and Gynecology
Odds Ratio
Pregnancy
Pregnancy Complications - diagnosis
Pregnancy Complications - etiology
pregnancy-related complications
Reproductive Techniques, Assisted - adverse effects
Risk Assessment
Risk Factors
singleton pregnancies
Title Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies
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https://www.clinicalkey.es/playcontent/1-s2.0-S001502821501924X
https://dx.doi.org/10.1016/j.fertnstert.2015.09.007
https://www.ncbi.nlm.nih.gov/pubmed/26453266
https://www.proquest.com/docview/1760903817
Volume 105
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