Adverse pregnancy outcomes in AMA and obese patients associated with advanced reproductive technology (ART)

Abstract

ART may be discouraged in obese and AMA patients due to perceived risk for adverse pregnancy outcomes (APOs). However, the relationships between obesity, maternal age, ART and APOs is uncertain. Thus, we evaluated differences in adverse pregnancy outcomes in obese and AMA patients with and without ART. This is a secondary analysis of the NuMoM2b cohort. All participants who continued pregnancy >20 weeks, followed to delivery, and had primary endpoint and key exposure data were included. Our primary exposure was ART, and our key modifying variables were obesity (BMI ≥30) and AMA (age ≥35). Our primary adverse pregnancy outcome (APO) endpoint was a composite of gestational diabetes, hypertensive disorder of pregnancy, abruption, preterm delivery, small for gestational age, and stillbirth. Secondary endpoints included neonatal morbidity. We tested for effect modification (interaction between ART and obesity, or AMA) in multivariable logistic regression. Among 9,261 participants ART (n=371) was associated with older age (33 vs 26, p < 0.001), non-Hispanic white race/ethnicity (80% vs 60%, p < 0.001), and income poverty line (98% vs 69% >200%, p < 0.001). When stratified by BMI ≥30 (n=2057), findings were consistent. The difference in race and ethnicity persisted among non-AMA, but not AMA women (n=859). The adjusted association between ART and APO was significant, but did not differ significantly by obesity or AMA (figure). Both obesity (1.8 (1.7, 2.0)) and AMA (1.4 (1.2, 1.6)) were independently associated with APO. Secondary endpoints of neonatal morbidity were not significantly associated with ART overall or when stratified by obesity or AMA (table). ART, obesity and AMA are independently associated with APO. However, obesity and AMA did not significantly modify the relationship between ART and APO. These findings suggest that obese and AMA populations do not have a significant increase in APO with the use of ART that differs from that of AMA with non-obese or younger women respectively.View Large Image Figure ViewerDownload Hi-res image Download (PPT)