Mortality and major morbidities in very preterm infants born from assisted conception or naturally conceived: results of the area-based ACTION study

BMC Pregnancy and Childbirth

Marina Cuttini⁶  Silvana Miniaci⁸  Virgilio Carnielli⁴  Franco Macagno¹  Luigi Gagliardi⁵  Domenico Di Lallo³  Monica Da Frè⁷  Carlo Corchia² 

[1] Neonatal Intensive Care Unit, S. Maria della Misericordia University Hospital, Udine, Italy;ICBD, International Centre on Birth Defects and Prematurity, via Carlo Mirabello 14, 00195 Rome, Italy;Unit of Epidemiology, Regional Health Agency of Lazio, Rome, Italy;Maternal and Child Health Institute, Marche University and Salesi Hospital, Ancona, Italy;Woman and Child Health Department, Pediatrics and Neonatology Division, Versilia Hospital, Viareggio, Italy;Unit of Epidemiology, Bambino Gesù Children’s Hospital, Rome, Italy;Unit of Epidemiology, Regional Health Agency of Tuscany, Florence, Italy;Neonatal Intensive Care Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy

关键词: Multiples;    Singletons;    Neonatal morbidity;    Neonatal mortality;    Preterm birth;    Assisted conception;   

Others  :  1125527
DOI  :  10.1186/1471-2393-14-307

 received in 2013-07-20, accepted in 2014-07-22,  发布年份 2014

【 摘 要 】

Background

The use of assisted conception (AC) has been associated with higher risk of adverse perinatal outcome. Few data are available on the outcome of AC-neonates when pregnancy ends before 32 weeks of gestational age.

The aim of this study was to compare the short-term outcome of AC- and naturally conceived preterm infants <32 weeks gestation.

Methods

The area-based cohort study ACTION collected data on births 22-31 weeks gestation occurred in 2003-05 in 6 Italian regions. Infants born to 2529 mothers with known mode of conception were studied. The main outcomes were hospital mortality and survival free from major morbidities (IVH grade 3-4, cPVL, ROP stage ≥3, BPD), and were assessed separately for single and multiple infants. Other outcomes were also investigated. Multivariable logistic analyses were used to adjust for maternal and infants’ characteristics. To account for the correlation of observations within intensive care units, robust variance and standard error estimates of regression parameters were computed.

Results

AC was used in 6.4% of mothers. Infants were 2934; 314 (10.7%) were born after AC. Multiples were 86.0% among AC and 21.7% among non-AC babies. In multivariable analysis no statistically significant difference in hospital mortality and survival without major morbidities was found between AC and non-AC infants. The risk of BPD was lower in AC than in non-AC multiples (aOR 0.41, CI 0.20-0.87), and this finding did not change after controlling for mechanical ventilation (aOR 0.42, CI 0.20-0.85) or presence of a patent ductus arteriosus (aOR 0.39, CI 0.18-0.84).

Conclusion

When the analysis is restricted to very preterm infants and stratified by multiplicity, no significant associations between AC and increased risk of short-term mortality and survival without major morbidities emerge. This result is consistent with previous studies, and may confirm the hypothesis that the adverse effects of AC are mediated by preterm birth. However, larger appropriately powered studies are needed before definitely excluding the possibility of adverse events linked to AC in infants born before 32 weeks gestation.

【 授权许可】

   
2014 Corchia et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Centers for Disease Control and Prevention: Assisted Reproductive Technology (ART) Report 2010. 2013. http://www.cdc.gov/art/artreports.htm webcite accessed April 22, 2013
• [2]Zeitlin J, Mohangoo AD, Delnord M, Cuttini M: EURO-PERISTAT Scientific Committee. The second European Perinatal Health Report: documenting changes over 6 years in the health of mothers and babies in Europe. J Epidemiol Community Health 2013, 67:983-985.
• [3]Human Fertilisation & Embryology Authority, UK: Fertility Treatment in 2011[http://www.hfea.gov.uk webcite] accessed April 22, 2013
• [4]Halliday J: Outcomes of IVF conceptions: are they different? Best Pract Res Clin Obstet Gynaecol 2007, 21:67-81.
• [5]Schieve LA, Cohen B, Nannini A, Ferre C, Reynolds MA, Zhang Z, Jeng G, Macaluso M, Wright WC: A population-based study of maternal and perinatal outcomes associated with assisted reproductive technology in Massachusetts. Matern Child Health J 2007, 11:517-525.
• [6]Davies MJ, Moore V, Willson K, Van Essen P, Priest K, Scott H, Haan EA, Chan A: Reproductive technologies and the risk of birth defects. N Engl J Med 2012, 366:1803-1813.
• [7]Wen J, Jiang J, Ding C, Dai J, Liu Y, Xia Y, Liu J, Hu Z: Birth defects in children conceived by in vitro fertilization and intracytoplasmic sperm injection: a meta-analysis. Fertil Steril 2012, 97:1331-1337.
• [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, 146:138-148.
• [9]McDonald SD, Han Z, Mulla S, Ohlsson A, Beyene J, Murphy KE: Preterm birth and low birth weight among in vitro fertilization twins: a systematic review and meta-analyses. Eur J Obstet Gynecol Reprod Biol 2010, 148:105-113.
• [10]Stewart JE, Allred EN, Collins M, Abbott J, Leviton A, Paneth N, Reuss ML, Susser M, Hegyi T, Hiatt M, Sanocka U, Shahrivar F, Van Marter L, Banogan P, Genest D, Heller D, Shen-Schwarz S, Dammann O, Kuban KCK, Pagano M: Risk of cranial ultrasound abnormalities in very-low-birth-weight infants conceived with assisted reproductive techniques. J Perinatol 2002, 22:37-45.
• [11]Hashimoto LN, Lindsell CJ, Brewer DE, Eichel MM, Donovan EF: Contributions of infertility treatment to very-low-birth-weight multiple birth infants receiving neonatal intensive care. Am J Obstet Gynecol 2004, 190:401-406.
• [12]Schimmel MS, Hammerman C, Lusky A, Reichman B: Very low-birth-weight-infants conceived by in vitro fertilization are not at higher risk for mortality and morbidity: a population-based study. Fertil Steril 2006, 85:907-912.
• [13]Messerschimdt A, Olischar M, Bimbacher R, Weber M, Pollack A, Leitich H: Perinatal outcome of preterm infants <1500 g after IVF pregnancies compared with natural conception. Arch Dis Child Fetal Neonatal Ed 2010, 95:F225-F229.
• [14]Shah V, AlWassia H, Shah K, Yoon W, Shah P: Neonatal outcomes among multiple births in ≤32 weeks gestational age: does mode of conception have an impact? a cohort study. BMC Pediatrics 2011, 11:54. BioMed Central Full Text
• [15]Picaud JC, Chalies S, Combes C, Mercier G, Dechaud H, Cambonie G: Neonatal mortality and morbidity in preterm infants born from assisted reproductive technologies. Acta Paediatr 2012, 101:846-851.
• [16]Tallandini MA, Morsan V, Macagno F: Preterm birth and assisted reproductive techniques/ART: maternal emotional wellbeing and quality of mother-infant interaction during the first three months of life. Early Hum Dev 2012, 88:397-402.
• [17]Italian Society for Obstetrical and Gynaecological Ecography: Guidelines 1010. Rome; 2010. [http://www.sieog.it/linee-guida/linee-guida-del-2010 webcite] Accessed November 9, 2013
• [18]Papiernik E, Zeitlin J, Delmas D, Blondel B, Künzel W, Cuttini M, Weber T, Petrou S, Gortner L, Kollée L, Draper ES, MOSAIC Group: Differences in outcome between twins and singletons born very preterm: results from a population-based European cohort. Hum Reprod 2010, 25:1035-1043.
• [19]McElrath TF, Hecht JL, Dammann O, Boggess K, Onderdonk A, Markenson G, Harper M, Delpapa E, Allred EN, Leviton A: Pregnancy disorders that lead to delivery before the 28th week of gestation: an epidemiologic approach to classification. Am J Epidemiol 2008, 168:980-989.
• [20]Zhang J, Merialdi M, Platt LD, Kramer MS: Defining normal and abnormal fetal growth: promises and challenges. Am J Obstet Gynecol 2010, 202:522-528.
• [21]Ancel P-Y, Marret S, Larroque B, Arnaud C, Zupan-Simunek V, Voyer M, Rozé J-C, Matis J, Burguet A, Ledésert B, André M, Pierrat V, Kaminski M, Epipage Study Group: Are maternal hypertension and small-for-gestational age risk factors for severe intraventricular hemorrhage and cystic periventricular leukonalacia? results of the EPIPAGE cohort study. Am J Obstet Gynecol 2005, 193:178-184.
• [22]Papile LA, Burstein J, Burstein R, Koffler H: Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978, 92:529-534.
• [23]de Vries LS: Neurological assessment of the preterm infant. Acta Paediatr 1996, 85:765-771.
• [24]Walsh MC, Kliegman RM: Review necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986, 33:179-201.
• [25]Williams RL: A note on robust variance estimation for cluster-correlated data. Biometrics 2000, 56:645-646.
• [26]Hsieh FY, Block DA, Larsen MD: A simple method of sample size calculation for linear and logistic regression. Stat Med 1998, 17:1623-1634.
• [27]Kalra SK, Molinaro TA: The association of in vitro fertilization and perinatal morbidity. Semin Reprod Med 2008, 26:423-425.
• [28]Williams C, Sutcliffe A: Infant outcomes of assisted reproduction. Early Hum Dev 2009, 85:673-677.
• [29]Pinborg A, Wennerholm UB, Romundstad LB, Loft A, Aittomaki K, Soderstrom-Anttila V, Nygren KG, Hazekamp J, Bergh C: Why do singletons conceived after assisted reproduction technology have adverse perinatal outcome? systematic review and meta-analysis. Hum Reprod Update 2013, 19:87-104.
• [30]Romundstad LB, Romundstad PR, Sunde A, von Düring V, Skjærven R, Gunnell D, Vatten LJ: Effects of technology or maternal factors on perinatal outcome after assisted fertilisation: a population-based cohort study. Lancet 2008, 372:737-743.
• [31]Boulet SL, Schieve LA, Nannini A, Ferre C, Devine O, Cohen B, Zhang Z, Wright V, Macaluso M: Perinatal outcomes of twin births conceived using assisted reproduction technology: a population-based study. Hum Reprod 2008, 23:1941-1948.
• [32]Corchia C, Mastroiacovo P: Health promotion in children, mothers and families: here’s why we should “think about it before conception”. Ital J Pediatr 2013, 39:68. epub ahead of print BioMed Central Full Text
• [33]Gagliardi L, Rusconi F, Da Frè M, Mello G, Carnielli V, Di Lallo D, Macagno F, Miniaci S, Corchia C, Cuttini M: Pregnancy disorders leading to very preterm birth influence neonatal outcomes: results of the population-based ACTION cohort study. Pediatr Res 2013, 73:794-801.
• [34]Corchia C, Ferrante P, Da Frè M, Di Lallo D, Gagliardi L, Carnielli V, Miniaci S, Piga S, Macagno F, Cuttini M: Cause-specific mortality of very preterm infants and antenatal events. J Pediatr 2013, 162:1125-1132.
• [35]Helmerhorst FM, Perquin DA, Donker D, Keirse MJ: Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ 2004, 328:261.
• [36]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.