Abstract
IntroductionAssisted reproductive technology (ART) and previous Cesarean section (CS) are independently associated with the risk of adverse obstetric and perinatal outcomes in general. Few studies have focused on the association between adverse obstetric and perinatal outcomes and ART used in the high-risk population of women with previous CS.Materials and MethodsA retrospective cohort study including 14,099 women with a previous delivery and a subsequent delivery between April 2014 and April 2020 was conducted at our hospital. We assessed the risk of adverse obstetric and perinatal outcomes in pregnancies conceived by ART in women with previous CS, using log-binomial regression models.ResultsIn women with previous CS, ART singleton pregnancies were associated with an increased risk of maternal complications, such as pregnancy complications, placental anomalies of implantation, postpartum hemorrhage, and preterm birth (PTB), as compared to spontaneously conceived pregnancies. The implementation of ART and previous CS interacted in a synergistic manner to increase the likelihood of the placenta accreta spectrum in women with singleton pregnancies [adjusted relative risk (aRR) 5.30, 95% confidence interval (CI) 4.01–7.00; relative risk due to interaction: 1.41, 95%CI 0.07–2.75]. In women with previous CS who underwent ART, women with singletons conceived through intracytoplasmic sperm injection were at increased risk of velamentous placenta (aRR 2.46, 95%CI 1.35–4.48) compared with those with singletons conceived through in vitro fertilization (IVF), whereas women with singletons conceived through cleavage-stage embryo transfer (ET) were at increased risk of gestational diabetes mellitus (GDM) (aRR 1.74, 95%CI 1.16-2.60) than those with singletons conceived through blastocyst–stage ET.ConclusionPregnancies conceived through ART were at increased risk for adverse obstetric and perinatal outcomes in women who had previously delivered by CS, particularly for placental anomalies of implantation. In women with previous CS undergoing ART, IVF and blastocyst–stage ET may be a relatively safe treatment.
Highlights
Assisted reproductive technology (ART) and previous Cesarean section (CS) are independently associated with the risk of adverse obstetric and perinatal outcomes in general
We investigated the interaction between the implementation of ART and previous CS on the risk of gestational diabetes mellitus (GDM) and placenta accreta spectrum in singleton pregnancies (Supplementary Table 2)
The obstetric and perinatal outcomes between different types of ART procedures used in women with previous CS were examined: women with singletons conceived through intracytoplasmic sperm injection (ICSI) were at increased risk of velamentous placenta compared with those with singletons conceived through in vitro fertilization (IVF); whereas women with singletons conceived through cleavage-stage embryo transfer (ET) were at increased
Summary
Assisted reproductive technology (ART) and previous Cesarean section (CS) are independently associated with the risk of adverse obstetric and perinatal outcomes in general. Few studies have focused on the association between adverse obstetric and perinatal outcomes and ART used in the high-risk population of women with previous CS. It is well-documented that Cesarean section (CS) might increase the incidence of adverse obstetric and perinatal outcomes in subsequent conceptions, including persistent complete placenta previa, placental abruption, uterine Cesarean scar rupture, preterm birth (PTB), and low birth weight (LBW) (Ventura Laveriano and Redondo, 2013; Hu et al, 2018; Granfors et al, 2020). Little is known about the effect of the type of ART procedure used in such women in relation to obstetric and perinatal outcomes
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