Advertisement

Hospitalization before and after delivery in fertile, subfertile, and ART-treated women

  • Judy E. SternEmail author
  • Chia-ling Liu
  • Howard Cabral
  • Elizabeth Harvey
  • Stacey A. Missmer
  • Hafsatou Diop
  • Charles C. Coddington
Assisted Reproduction Technologies
  • 3 Downloads

Abstract

Purpose

Pre-pregnancy and post-delivery hospitalizations were compared as markers for health among women who conceived using assisted reproductive technology (ART), non-ART medically assisted reproduction (MAR), no treatment (unassisted subfertile), and who were fertile.

Methods

We analyzed hospital discharge data linked to Massachusetts birth certificates from 2004 to 2013 within 5 years prior to pregnancy and 8–365 days post-delivery. ART deliveries were linked from a national ART database; MAR deliveries had fertility treatment but not ART; unassisted subfertile women had subfertility but no ART or MAR; and fertile women had none of these. Prevalence of diagnoses during hospitalization was quantified. Multivariable logistic regression models with fertile deliveries as reference were adjusted for maternal age, race, education, year, and plurality (post-delivery only) with results reported as adjusted odds ratios (AORs) and 95% confidence intervals (CI).

Results

Of 170,605 privately insured, primiparous deliveries, 10,458 were ART, 3005 MAR, 1365 unassisted subfertile, and 155,777 fertile. Pre-pregnancy hospitalization occurred in 6.8% and post-delivery in 2.8% of fertile women. Subfertile groups had more pre-pregnancy hospitalizations (AOR, 95% CI: 1.84, 1.72–1.96 ART; 1.41, 1.24–1.60 MAR; 3.02, 2.62–3.47 unassisted subfertile) with endometriosis, reproductive organ disease, ectopic pregnancy/miscarriage, and disorders of menstruation, ovulation, and genital tract being common. Post-delivery hospitalizations were significantly more frequent in the ART (AOR 1.19, 95% CI 1.05–1.34) and unassisted subfertile (1.59, 1.23–2.07) groups with more digestive tract disorders, thyroid problems, and other grouped chronic disease conditions.

Conclusions

Greater likelihood of hospitalization in the ART, MAR, and unassisted subfertile groups is largely explained by admissions for conditions associated with subfertility.

Keywords

Assisted reproductive technology In vitro fertilization Medically assisted reproduction Hospitalization Subfertility Women’s health 

Notes

Acknowledgments

SART wishes to thank all of its members for providing clinical information to the SART CORS database for use by patients and researchers. Without the efforts of our members, this research would not have been possible.

Funding

NIH R01HD067270

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Toner JP, Coddington CC, Doody K, Van Voorhis B, Seifer DB, Ball GD, et al. Society for Assisted Reproductive Technology and assisted reproductive technology in the United States: a 2016 update. Fertil Steril. 2016;106:541–6.CrossRefGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention. Figures from the 2014 Assisted Reproductive Technology National Summary Report. https://www.cdc.gov/art/pdf/2014-national-summary-slides/art_2014_graphs_and_charts.pdf. Accessed 11/19/2018.
  3. 3.
    Sunderam S, Kissin DM, Crawford SB, Folger SG, Boulet SL, Warner L, et al. Assisted reproductive technology surveillance - United States, 2015. MMWR Surveill Summ. 2018;67(3):1–28.CrossRefGoogle Scholar
  4. 4.
    Jahromi BN, Parsanezhad ME, Shomali Z, Bakhshai P, Alborzi M, Vaziri NM, et al. Ovarian hyperstimulation syndrome: a narrative review of its pathophysiology, risk factors, prevention, classification, and management. IJMS. 2018;43(3):248–60.Google Scholar
  5. 5.
    Levi-Setti PE, Cirillo F, Scolaro V, Morenghi E, Heilbron F, Girardello D, et al. Appraisal of clinical complications after 23,827 oocyte retrievals in a large assisted reproductive technology program. Fertil Steril. 2018;109(6):1038–1043.e1.CrossRefGoogle Scholar
  6. 6.
    Helmerhorst FM, Perquin DAM, Donker D, Keirse JNC. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ. 2004;328:261–6.CrossRefGoogle Scholar
  7. 7.
    Allen VM, Wilson RD, Cheung A, Blight C, Desilets VA, Gagnon A, et al. Pregnancy outcomes after assisted reproductive technology. J Obstet Gynaecol Can. 2006;28:220–33.CrossRefGoogle Scholar
  8. 8.
    Declercq ER, Belanoff C, Diop H, Gopal D, Hornstein MD, Kotelchuck M, et al. Identifying women with indicators of subfertility in a statewide population database: operationalizing the missing link in assisted reproductive technology research. Fertil Steril. 2014;101(2):463–71.CrossRefGoogle Scholar
  9. 9.
    Luke B, Stern JE, Kotelchuck M, Declercq E, Gopal D, Hoang L, et al. Adverse pregnancy outcomes after in vitro fertilization: effect of number of embryos transferred and plurality at conception. Fertil Steril. 2015;104:79–86.CrossRefGoogle Scholar
  10. 10.
    Stern JE, Luke B, Tobias M, Gopal D, Hornstein MD, Diop H. Adverse pregnancy and birth outcomes by infertility diagnoses with and without ART treatment. Fertil Steril. 2015;103:1438–45.CrossRefGoogle Scholar
  11. 11.
    Belanoff CB, Declercq ER, Diop H, Gopal D, Kotelchuck M, Luke B, et al. Severe maternal morbidity and the use of assisted reproductive technology in Massachusetts. Obstet Gynecol. 2016;127:527–34.CrossRefGoogle Scholar
  12. 12.
    Martin AS, Monsour M, Kissin DM, Jamieson DJ, Callaghan WM, Boulet SL. Trends in severe maternal morbidity after assisted reproductive technology in the United States, 2008–2012. Obstet Gynecol. 2016;127:59–66.CrossRefGoogle Scholar
  13. 13.
    Sabban H, Zakhari A, Patenaude V, Tulandi T, Abenhaim HA. Obstetrical and perinatal morbidity and mortality among in-vitro fertilization pregnancies: a population-based study. Arch Gynecol Obstet. 2017;296:107–13.CrossRefGoogle Scholar
  14. 14.
    Luke B, Stern JE, Hornstein MD, Kotelchuck M, Diop H, Cabral H, et al. Is the wrong question being asked in infertility research? JARG. 2016;33:3–8.Google Scholar
  15. 15.
    Stern JE, Gopal D, Diop H, Missmer SA, Coddington CC, Luke B. Inpatient hospitalizations in women with and without assisted reproductive technology live birth. J Assist Reprod Genet. 2017;34:1043–9.  https://doi.org/10.1007/s10815-017-0961-z.CrossRefGoogle Scholar
  16. 16.
    Kotelchuck M, Hoang L, Stern JE, Diop H, Belanoff C, Declercq ER. The MOSART database: linking the SART CORS clinical database to the population-based Massachusetts PELL reproductive public health data system. Matern Child Health J. 2014;18(9):2167–78.CrossRefGoogle Scholar
  17. 17.
    Kawwass JF, Kissin DM, Kulkarni AD, Creanga AA, Session DR, Callaghan WM, et al. Safety of assisted reproductive technology in the United States, 2000–2011. JAMA. 2015;313:88–90.CrossRefGoogle Scholar
  18. 18.
    Bosteels J, Weyers S, Mathieu C, Mol W, Hooghe TD. The effectiveness of reproductive surgery in the treatment of female infertility: facts, views and vision. Facts Views Vis Obgyn. 2010;2:232–52.Google Scholar
  19. 19.
    Hassa H, Aydin Y. The role of laparoscopy in the management of infertility. J Obstet Gynaecol. 2014;34:1–7.CrossRefGoogle Scholar
  20. 20.
    Kodaman PH. Current strategies for endometriosis management. Obstet Gynecol Clin. 2015;42:87–101.CrossRefGoogle Scholar
  21. 21.
    Costello MF, Ledger WL. Evidence-based management of infertility in women with polycystic ovary syndrome using surgery or assisted reproductive technology. Women Health. 2012;8:291–300.CrossRefGoogle Scholar
  22. 22.
    Yli-Kuha AN, Gissler M, Klemetti R, Luoto R, Koivisto E, Hemminki E. Psychiatric disorders leading to hospitalization before and after infertility treatments. Hum Reprod. 2010;25:2018–23.CrossRefGoogle Scholar
  23. 23.
    Baldur-Felskov B, Kjaer SK, Albieri V, Steding-Jessen M, Kjaer T, Johansen C, et al. Psychiatric disorders in women with fertility problems: results from a large Danish register-based cohort study. Hum Reprod. 2013;28:683–90.  https://doi.org/10.1093/humrep/des422.CrossRefGoogle Scholar
  24. 24.
    Stern JE, Liu CL, Cabral HJ, Richards EG, Coddington CC, Missmer SA, et al. Factors associated with the increased odds of cesarean delivery in ART pregnancies. Fertil Steril. 2018;110(3):429–36.CrossRefGoogle Scholar
  25. 25.
    Maraka S, Singh Ospina NM, Ospina NM, O’Keeffe DT, Espinosa De Ycaza AE, Gionfriddo MR, et al. Subclinical hypothyroidism in pregnancy: a systematic review and meta-analysis. Thyroid. 2016 Apr;26(4):580–90.  https://doi.org/10.1089/thy.2015.0418.CrossRefGoogle Scholar
  26. 26.
    Maraka S, Singh Ospina NM, O’Keeffe DT, Rodriguez-Gutierrez R, Espinosa De Ycaza AE, Wi CI, et al. Effects of levothyroxine therapy on pregnancy outcomes in women with subclinical hypothyroidism. Thyroid. 2016;26(7):980–6.  https://doi.org/10.1089/thy.2016.0014.CrossRefGoogle Scholar
  27. 27.
    Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21(10):1081–125.CrossRefGoogle Scholar
  28. 28.
    De Groot L, Abalovich M, Alexander EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(8):2543–65.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics & GynecologyDartmouth-HitchcockLebanonUSA
  2. 2.Bureau of Family Health and NutritionMassachusetts Department of Public HealthBostonUSA
  3. 3.Department of BiostatisticsBoston University School of Public HealthBostonUSA
  4. 4.Department of Obstetrics, Gynecology, and Reproductive BiologyMichigan State UniversityGrand RapidsUSA
  5. 5.Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonUSA
  6. 6.Atrium HealthCharlotteUSA

Personalised recommendations