737: Severe maternal morbidity and mortality associated with assisted reproduction: A population-based study

Abstract

Objective: To quantify the incidence of severe maternal morbidity and mortality following use of assisted reproductive technology (ART). Study Design: We carried out a population-based retrospective cohort study of all hospital live births at >=20 weeks' gestation in Canada (excluding Quebec) between 2009 and 2012. We used data from the Canadian Institute for Health Information, which contains information on all hospital separation including maternal characteristics and delivery details. Severe maternal morbidity (both composite and specific), case fatality, and length of hospitalization associated with assisted reproductive technology were quantified. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were estimated using logistic regression after adjusting for maternal age and parity. Result(s): Among the 1,993,946 women who delivered between 2009 and 2012, there were 46,029 deliveries in the ART group (2.3%). The rate of composite severe maternal morbidity in the ART group was 29.8 (95% CI 28.3-31.4) per 1,000 deliveries vs 10.4 (95% CI 10.3-10.6) per 1,000 deliveries in the non-ART group (rate ratio 2.86, 95% CI 2.71-3.02). The median length of hospital stay for women with and without ART was 4 days versus 3 days, while the frequency of prolonged hospital stay (>= 7 days) was 6.4% versus 1.5%, respectively (Table 1). Logistic regression analysis with adjustment for maternal age and parity showed that ART was associated with significantly higher rates of composite severe maternal morbidity and mortality (AOR 1.75, 95% CI 1.63-1.88). The excess composite severe maternal morbidity was due to increases in severe preeclampsia or HELLP syndrome (AOR 1.55, 1.37-1.76), severe postpartum hemorrhage (AOR 2.31, 1.89-2.82), hysterectomy (AOR 2.06, 1.73-2.46), disseminated intravascular coagulation (AOR 2.20, 1.10-4.43), acute fatty liver requiring red cell or plasma transfusion (AOR 2.04, 1.19-3.52) and other morbidity (Table 2). The mortality rate in the ART group was as 5.43 per 100,000 compared with 3.03 per 100,000 deliveries in the non-ART group (rate ratio 1.79, 95% CI 0.51-6.36). Conclusion(s): Women who use ART are at increased risk of life-threatening severe maternal morbidity and maternal mortality and warrant appropriate counselling and vigilance before and during pregnancy and childbirth. [Figure presented] [Figure presented]Copyright © 2018