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Pregnancy and perinatal outcomes after assisted reproduction: a comparative study

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Abstract

Background

Increasing use of fertility therapy has elicited concerns regarding adverse effects for expectant mothers and the health of children thus conceived.

Aims

To study the risk of adverse perinatal outcomes, birth defects and pregnancy complications following assisted reproductive technology (ART).

Methods

Questionnaire-based study involving 1,524 children and 1,182 pregnancies conceived following in vitro fertilisation (IVF) in two units. Outcomes were compared with the general population.

Results

In the study group versus the general population; multi-foetal gestations, 26 versus 2%; singleton preterm delivery and low birth weight, 8.7 and 6.4 versus 4.3 and 4%, respectively; non-lethal congenital malformation rate, 2.6 versus 2.1%; placenta praevia, 2.8 versus 0.5%.

Conclusions

Multi-foetal gestations remain the principal cause of adverse perinatal outcomes after ART. Singleton ART pregnancies have an increased risk of preterm delivery and low birth weight at term. Non-lethal congenital malformation rates are not increased following ART. Placenta praevia is increased following ART.

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Acknowledgments

The authors wish to acknowledge the support of their work by the Children’s Medical and Research Foundation at Our Lady’s Hospital for Sick Children, Dublin, which generously funds Dr. Reardon’s research interests. We kindly appreciate the help of Professor Ronan Conroy, Department of Epidemiology, Royal College of Surgeons in Ireland, with statistical interpretation. We especially wish to thank the families involved.

Disclosure of interest

There is no duality of interest that we wish to declare.

Contribution to authorship

C. Allen collected the data, performed the analyses and wrote the paper. S. Bowdin, R. F. Harrison, L. Brueton, G. Kirby, C. Barrett assisted in identifying study participants and in collecting the data. A. Sutcliffe, J. Kirkman-Brown, edited the paper. W. Reardon and E. Maher designed the original study protocol.

Details of ethics approval

Ethics approval to perform this study was granted by the Research Ethics Committees of the Rotunda Hospital, Dublin and Birmingham Women’s Healthcare Trust.

Funding

This study was supported with funding by the Children’s Medical and Research Foundation at Our Lady’s Hospital for Sick Children, Dublin.

Author information

Authors and Affiliations

  1. Human Assisted Reproduction Ireland, Rotunda Hospital, Dublin, Ireland

    C. Allen & R. F. Harrison

  2. West Midlands Regional Genetics Service, Birmingham Womens Healthcare NHS Trust, Birmingham, BT15 2TG, UK

    S. Bowdin, L. Brueton & G. Kirby

  3. Royal Free and University College Medical School, University College London, London, UK

    A. G. Sutcliffe

  4. Reproductive Biology and Genetics Group, The Medical School, University of Birmingham, Birmingham, BT15 2TT, UK

    J. Kirkman-Brown & C. Barrett

  5. National Centre for Medical Genetics, Our Lady’s Hospital for Sick Children, Crumlin, Dublin, Ireland

    W. Reardon

  6. Section of Medical and Molecular Genetics, University of Brimingham, Birmingham, BT15 2TT, UK

    E. Maher

Authors
  1. C. Allen
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  2. S. Bowdin
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  3. R. F. Harrison
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  4. A. G. Sutcliffe
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  5. L. Brueton
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  6. G. Kirby
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  7. J. Kirkman-Brown
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  8. C. Barrett
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  9. W. Reardon
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  10. E. Maher
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Corresponding author

Correspondence to C. Allen.

Appendices

Appendix 1. Questionnaire

History of the conception and pregnancy

  1. 1.

    By what method was your child conceived? IVF/ICSI

  2. 2.

    How many embryos/zygotes were re-implanted?

  3. 3.

    How many babies born?

  4. 4.

    Number of weeks gestation at birth?

  5. 5.

    Were there any complications during pregnancy?

  6. 6.

    If yes, please elaborate.

  7. 7.

    Birth weight (in kg please)?

  8. 8.

    Were the embryos/zygotes frozen for a period before implantation?

  9. 9.

    Was clomiphene (Clomid) ever used to induce ovulation in your case?

  10. 10.

    Did you need to use other drugs as part of the infertility treatment?

  11. 11.

    Do you know what those drugs were?

  12. 12.

    Father’s age at conception?

  13. 13.

    Mother’s age at conception?

Specific queries

  1. 1.

    Has your child developed normally?

  2. 2.

    Does your child have normal speech?

  3. 3.

    Is your child’s movement normal?

  4. 4.

    Has your child ever had epilepsy?

  5. 5.

    Has anybody expressed concern about your child’s growth?

  6. 6.

    Does your child have learning problems.

  7. 7.

    What is your child’s current weight?

  8. 8.

    What is your child’s current height?

  9. 9.

    Has your child needed to be seen by a paediatrician?

    1. a.

      What problem caused you to seek a paediatric opinion?

    2. b.

      What diagnosis was reached?

    3. c.

      Who is your child’s paediatrician?

Birth defects

  1. 1.

    Did your child have any birth defects?

  2. 2.

    If yes, please indicate the doctor and hospital where treated.

  3. 3.

    Do you give your consent for us to request the medical records relating to your child?

  4. 4.

    Abnormalities noted in the baby.

  5. 5.

    Has your child ever needed surgery?

  6. 6.

    If yes, please detail why.

    1. a.

      Surgery was needed?

    2. b.

      Where performed ?

    3. c.

      Surgeon who cared for your child?

  7. 1.

    Has your child ever needed to have a chromosome test?

  8. 2.

    Do you know what the result was?

Appendix 2. Data sources used for local general populations

 

Area

Parameter

Data source

Year

Dublin

Gestational age, birth weight

National Perinatal Reporting System, Ireland

2001

Birth defects

EUROCAT Register, Dublin Galway

1980–1999

Pregnancy complications

Dublin Maternity Hospitals reports

2000–2004

Birmingham

Gestational age, birth weight

Information and Statistics Division, SMR2 Maternity Discharge Sheet (Scotland)

2000

Birth defects

EUROCAT Register, North Thames, Wales

1980–1999

Pregnancy complications

Dublin Maternity Hospital Reports

2000–2004

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Allen, C., Bowdin, S., Harrison, R.F. et al. Pregnancy and perinatal outcomes after assisted reproduction: a comparative study. Ir J Med Sci 177, 233–241 (2008). https://doi.org/10.1007/s11845-008-0172-9

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