Pregnancy following assisted reproductive technology in morbidly obese patients: assessment of feto-maternal outcomes

Abstract

Purpose: To examine feto-maternal characteristics and outcomes of morbidly obese pregnant patients who conceived with assisted reproductive technology (ART). Methods: This cross-sectional study queried the Healthcare Cost and Utilization Project’s National Inpatient Sample. Study population was 48,365 patients with ART pregnancy from January 2012 to September 2015, including non-obesity (n = 45,125, 93.3%), class I–II obesity (n = 2445, 5.1%), and class III obesity (n = 795, 1.6%). Severe maternal morbidity at delivery per the Centers for Disease and Control Prevention definition was assessed with multivariable binary logistic regression model. Results: Patients in the class III obesity group were more likely to have a hypertensive disorder (adjusted-odds ratio (aOR) 3.03, 95% confidence interval (CI) 2.61–3.52), diabetes mellitus (aOR 3.08, 95%CI 2.64–3.60), large for gestational age neonate (aOR 3.57, 95%CI 2.77–4.60), and intrauterine fetal demise (aOR 2.03, 95%CI 1.05–3.94) compared to those in the non-obesity group. Increased risks of hypertensive disease (aOR 1.35, 95%CI 1.14–1.60) and diabetes mellitus (aOR 1.39, 95%CI 1.17–1.66) in the class III obesity group remained robust even compared to the class I–II obesity group. After controlling for priori selected clinical, pregnancy, and delivery factors, patients with class III obesity were 70% more likely to have severe maternal morbidity at delivery compared to non-obese patients (8.2% vs 4.4%, aOR 1.70, 95%CI 1.30–2.22) whereas those with class I–II obesity were not (4.1% vs 4.4%, aOR 0.87, 95%CI 0.70–1.08). Conclusions: The results of this national-level analysis in the United States suggested that morbidly obese pregnant patients conceived with ART have increased risks of adverse fetal and maternal outcomes.