Perinatal mortality following assisted reproductive technology treatment in Australia and New Zealand, a public health approach for international reporting of perinatal mortality

BMC Pregnancy and Childbirth

Cynthia M Farquhar²  Abrar Ahmad Chughtai⁴  Georgina M Chambers⁴  Robert J Norman¹  Yueping A Wang⁴  Elizabeth A Sullivan³ 

[1] Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide 5005 SA, Australia;Department of Obstetrics and Gynaecology, University of Auckland, Auckland 1020, New Zealand;National Perinatal Epidemiology and Statistics Unit, Level 2, McNevin Dickson Building, Randwick Hospitals Campus, Randwick 2031, NSW, Australia;National Perinatal Epidemiology and Statistics Unit, The University of New South Wales, Sydney 2052 NSW, Australia

关键词: Neonatal mortality;    Stillbirth;    Embryo transfer;    Assisted reproductive technology treatment;    Perinatal mortality;   

Others  :  1137874
DOI  :  10.1186/1471-2393-13-177

 received in 2013-03-26, accepted in 2013-09-02,  发布年份 2013

【 摘 要 】

Background

There is a need to have uniformed reporting of perinatal mortality for births following assisted reproductive technology (ART) treatment to enable international comparison and benchmarking of ART practice.

Methods

The Australian and New Zealand Assisted Reproduction Database was used in this study. Births of ≥ 20 weeks gestation and/or ≥ 400 grams of birth weight following embryos transfer cycles in Australia and New Zealand during the period 2004 to 2008 were included. Differences in the mortality rates by different perinatal periods from a gestational age cutoff of ≥ 20, ≥ 22, ≥ 24, or ≥ 28 weeks (wks) to a neonatal period cutoff of either < 7 or < 28 days after birth were assessed. Crude and specific (number of embryos transferred and plurality) rates of perinatal mortality were calculated for selected gestational and neonatal periods.

Results

When the perinatal period is defined as ≥ 20 wks gestation to < 28 days after birth, the perinatal mortality rate (PMR) was 16.1 per 1000 births (n = 630). A progressive contraction of the gestational age groups resulted in marked reductions in the PMR for deaths at < 28 days (22 wks 11.0; 24 wks 7.7; 28 wks 5.6); and similarly for deaths at < 7 days (20 wks 15.6, 22 wks 10.5; 24 wks 7.3; 28 wks 5.3). In contrast, a contraction of the perinatal period from < 28 to < 7 days after birth only marginally reduced the PMR from 16.2 to 15.6 per 1000 births which was consistent across all gestational ages.

The PMR for single embryo transfer (SET) births (≥ 20 weeks gestation to < 7 days post-birth) was significantly lower (12.8 per 1000 SET births) compared to double embryo transfer (DET) births (PMR 18.3 per 1000 DET births; p < 0.001, Fisher’s Exact Test). Similarly, the PMR for SET births (≥ 22 weeks gestation to < 7 days post-birth) was significantly lower (8.8 per 1000 SET births, p < 0.001, Fisher’s Exact Test) when compared to DET births (12.2 per 1000 DET births). The highest PMR (50.5 per 1000 SET births, 95% CI 36.5-64.5) was for twins following SET births (≥ 20 weeks gestation to < 7 days post-birth) compared to twins following DET (23.9 per 1000 DET births, 95% CI 20.8-27.1).

Conclusion

Reporting of perinatal mortality of ART births is an essential component of quality ART practice. This should include measures that monitor the impact on perinatal mortality of multiple embryo transfer. We recommend that reporting of perinatal deaths following ART treatment, should be stratified for three gestation-specific perinatal periods of ≥ 20, ≥ 22 and ≥ 28 completed weeks to < 7 days post-birth; and include plurality specific rates by SET and DET. This would provide a valuable international evidence-base of PMR for use in evaluating ART policy, practice and new research.

【 授权许可】

   
2013 Sullivan et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]World Health Organization (WHO): Neonatal and perinatal mortality: country, regional and global estimates 2004. Geneva; 2007.
• [2]Macaldowie A, Wang YA, Chambers GM, Sullivan EA: Assisted reproductive technology in Australia and New Zealand 2010: assisted reproduction technology series: Cat. no. PER 55. Canberra: AIHW; 2012.
• [3]Gunby J, Bissonnette F, Librach C, Cowan L: Assisted reproductive technologies (ART) in Canada: 2007 results from the Canadian ART register. Fertil Steril 2011, 95(2):542-7.e10.
• [4]Zegers-Hochschild F, Schwarze JE, Crosby JA, Souza Mdo C: Twenty years of Assisted Reproductive Technology (ART) in Latin America. J Bras de Reproducao Assistida 2011, 15(2):19-30.
• [5]Human Fertilisation & Embryology Authority (HFEA): Annual report and accounts 2011/12. [cited 2012 15 Deccember]; Available from: http://www.hfea.gov.uk/docs/ISBN_978-0-10-297633-5_WEB.pdf webcite
• [6]Ferraretti AP, Goossens V, Mouzon J, Bhattacharya S, Castilla JA, Korsak V, et al.: Assisted reproductive technology in Europe, 2008: results generated from European registers by ESHRE. Hum Reprod 2012, 27(9):2571-2584.
• [7]Centers for Disease Control and Prevention (CDC): Assisted reproductive technology report (2010). Atlanta, GA; 2012.
• [8]Barfield WD, Papile LA, Baley JE, Bhutani VK, Carlo WA, Cummings JJ, et al.: Clinical reports–standard terminology for fetal, infant, and perinatal deaths. Pediatrics 2011, 128(1):177-181.
• [9]Li Z, Zeki R, Hilder L, Sullivan EA: Australia’s mothers and babies 2010: perinatal statistics series no. 27: Cat. no. PER 57. Canberra: AIHW; 2012.
• [10]World Health Organization: Neonatal and perinatal mortality: country, regional and global estimates. Geneva: World Health Organization, Safer DoMP; 2006.
• [11]Tucker J, McGuire W: Epidemiology of preterm birth. BMJ 2004, 329(7467):675-678. [Review]
• [12]Zegers-Hochschild F, Adamson GD, De Mouzon J, Ishihara O, Mansour R, Nygren K, et al.: International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009. Fertil Steril 2009, 92(5):1520-1524. Dictionary
• [13]Pandian Z, Bhattacharya S, Ozturk O, Serour G, Templeton A: Number of embryos for transfer following in-vitro fertilisation or intra-cytoplasmic sperm injection. Cochrane Database Syst Rev 2009, 15(2):CD003416.
• [14]Bissonnette F, Phillips SJ, Gunby J, Holzer H, Mahutte N, St-Michel P, et al.: Working to eliminate multiple pregnancies: a success story in Québec. Reprod Biomed Online 2011, 23(4):500-504.
• [15]Saldeen P, Sundstrom P: Would legislation imposing single embryo transfer be a feasible way to reduce the rate of multiple pregnancies after IVF treatment? Hum Reprod 2005, 20(1):4-8.
• [16]Farquhar CM, Wang YA, Sullivan EA: A comparative analysis of assisted reproductive technology cycles in Australia and New Zealand 2004-2007. Hum Reprod 2010, 25(9):2281-2289.
• [17]Karlstrom PO, Bergh C: Reducing the number of embryos transferred in Sweden impact on delivery and multiple birth rates. Hum Reprod 2007, 8:2202-2207.
• [18]Gordts S, Campo R, Puttemans P, Brosens I, Valkenburg M, Norre J, et al.: Belgian legislation and the effect of elective single embryo transfer on IVF outcome. Reprod Biomed Online 2005, 10(4):436-441.
• [19]Sullivan EA, Zegers-Hochschild F, Mansour R, Ishihara O, de Mouzon J, Nygren KG, Adamson GD: International Committee for Monitoring Assisted Reproductive Technologies (ICMART) world report: assisted reproductive technology 2004. Hum Reprod 2013, 28(5):1375-1390. Research Support, Non-U.S. Gov’t. 2012
• [20]Lawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C: Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data. BMC Pregnancy Childbirth 2010, 10(1):1-22. BioMed Central Full Text
• [21]Public Health Agency of Canada: Canadian perinatal health report. 2008.
• [22]The Health Quality & Safety Commission New Zealand: Perinatal data collection. [cited 2012 15 December]; Available from: http://www.hqsc.govt.nz/our-programmes/mrc/pmmrc/perinatal-information/perinatal-data-collection/ webcite
• [23]Li Z, McNally L, Hilder L, Sullivan EA: Australia’s mothers and babies 2009. Canberra: AIHW; 2011. Contract No.: Cat. no. PER 52
• [24]Centers for Disease Control and Prevention (CDC): National vital statistics system, fetal deaths. [cited 2012 15 Deccember]; Available from: http://www.cdc.gov/nchs/fetal_death.htm webcite
• [25]Australian Bureau of Statistics (ABS): Perinatal deaths. Australia: Gender Indicators; 2011. [cited 2012 15 December]; Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by+Subject/4125.0~Jul+2011~Main+Features~Perinatal+Deaths~3270 webcite
• [26]Romundstad LB, Romundstad PR, Sunde A, Von During V, Skjaerven R, Gunnell D, et al.: Effects of technology or maternal factors on perinatal outcome after assisted fertilisation: a population-based cohort study. Lancet 2008, 372(9640):737-743. [Research Support, Non-U.S. Gov’t]
• [27]Pelkonen S, Koivunen R, Gissler M, Nuojua-Huttunen S, Suikkari AM, Hyden-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(4):914-923. [Research Support, Non-U.S. Gov’t]
• [28]Macfarlane A, Gissler M, Bolumar F, Rasmussen S: The availability of perinatal health indicators in Europe. Eur J Obstet Gynecol Reprod Biol 2003, 111:S15-S32.
• [29]Perinatal Institute Office for National Statistics UK: Perinatal mortality definitions. 2012. Available from: http://www.perinatal.nhs.uk/pnm/definitions.htm webcite
• [30]European Perinatal Health Report: EURO-PERISTAT Project, with SCPE, EUROCAT, EURONEOSTAT: European perinatal health report. 2008. Available: http://www.europeristat.com/reports.html webcite
• [31]Anonymised HFEA data [database on the Internet]: HREA. 2010. [cited 15 August 2011]. Available from: http://www.hfea.gov.uk/5874.html webcite
• [32]Kramer MS, McLean FH, Boyd ME, Robert H, Usher M: The validity of gestational age estimation by menstrual dating in term, preterm, and postterm gestations. JAMA 1988, 260(22):3306-3308.
• [33]Mohangoo AD, Blondel B, Gissler M, Velebil P, Macfarlane A: International comparisons of fetal and neonatal mortality rates in high-income countries: should exclusion thresholds be based on birth weight or gestational age? PLoS One 2013, 8(5):e64869.
• [34]Macaldowie A, Wang YA, Chambers GM, Sullivan EA: Assisted reproductive technology in Australia and New Zealand 2010. AIHW: Assisted reproduction technology series Canberra; 2012.
• [35]Centers for Disease Control and Prevention (CDC): 2006 Assisted reproductive technology success rate, national summary and fertility clinic reports. Atlanta, GA; 2008.
• [36]Joseph KS, Liu S, Rouleau J, Lisonkova S, Hutcheon JA, Sauve R, et al.: Influence of definition based versus pragmatic birth registration on international comparisons of perinatal and infant mortality: population based retrospective study. BMJ 2012, 344:1-9.
• [37]Reynolds MA, Schieve LA: Trends in embryo transfer practices and multiple gestation for IVF procedures in the USA, 1996-2002. Hum Reprod 2006, 21(3):694-700.
• [38]Sazonova A, Kllen K, Thurin-Kjellberg A, Wennerholm UB, Bergh C: Factors affecting obstetric outcome of singletons born after IVF. Hum Reprod 2011, 26(10):2878-2886.
• [39]Poikkeus P, Gissler M, Unkila-Kallio L, Hyden-Granskog C, Tiitinen A: Obstetric and neonatal outcome after single embryo transfer. Hum Reprod 2007, 22(4):1073-1079.
• [40]Wang YA, Sullivan EA, Healy DL, Black DA: Perinatal outcomes after assisted reproductive technology treatment in Australia and New Zealand: single versus double embryo transfer. Med J Australia 2009, 190(5):234-237. [Comparative Study Research Support, Non-U.S. Gov’t]
• [41]Vitthala S, Gelbaya TA, Brison DR, Fitzgerald CT, Nardo LG: The risk of monozygotic twins after assisted reproductive technology: a systematic review and meta-analysis. Hum Reprod 2009, 15(1):45-55. Update
• [42]Boulet SL, Schieve LA, Nannini A, Ferre C, Devine O, Cohen B, et al.: Perinatal outcomes of twin births conceived using assisted reproduction technology: a population-based study. Hum Reprod 2008, 23(8):1941-1948. [Research Support, U.S. Gov’t, Non-P.H.S.]
• [43]Sullivan E, Hilder L, Wang Y: Perinatal mortality and cause of death in babies born in Australia: a population study of all births including those following assisted reproductive technologies. Hum Reprod 2013, 28(suppl 1):i68-i71.
• [44]Finnström O, Källén B, Lindam A, Nilsson E, Nygren KG, Olausson PO: Maternal and child outcome after in vitro fertilization–a review of 25 years of population-based data from Sweden. Acta Obstet Gynecol Scand 2011, 90(5):494-500.
• [45]Adler-Levy Y, Lunenfeld E, Levy A: Obstetric outcome of twin pregnancies conceived by in vitro fertilization and ovulation induction compared with those conceived spontaneously. Eur J Obstet Gynecol Reprod Biol 2007, 133(2):173-178.
• [46]El-Chaar D, Yang Q, Gao J, Bottomley J, Leader A, Wen SW, et al.: Risk of birth defects increased in pregnancies conceived by assisted human reproduction. Fertil Steril 2009, 92(5):1557-1561.
• [47]Davies MJ, Moore VM, Willson KJ, Van Essen P, Priest K, Scott H, et al.: Reproductive technologies and the risk of birth defects. N Engl J Med 2012, 366(19):1803-1813.