Hospitalization before and after delivery in fertile, subfertile, and ART-treated women
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ASSISTED REPRODUCTION TECHNOLOGIES
Hospitalization before and after delivery in fertile, subfertile, and ART-treated women Judy E. Stern 1 & Chia-ling Liu 2 & Howard Cabral 3 & Elizabeth Harvey 2 & Stacey A. Missmer 4,5 & Hafsatou Diop 2 & Charles C. Coddington 6 Received: 5 June 2019 / Accepted: 8 August 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019
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.
Presented at ESHRE, 2018 Barcelona, Spain (pre-delivery hospitalizations), and ASRM, 2018 Denver CO (post-delivery hospitalizations) * Judy E. Stern [email protected] 1
Department of Obstetrics & Gynecology, Dartmouth-Hitchcock, One Medical Center Drive, Lebanon, NH 03756, USA
2
Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, MA, USA
3
Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
4
Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
5
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
6
Atrium Health, Charlotte, NC 28204, USA
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