title: Risk of poor neonatal outcome at term after medically assisted reproduction: a propensity score-matched study.
abstract: OBJECTIVE
  To study risk of birth asphyxia and related morbidity among term singletons born after medically assisted reproduction (MAR).
  
  
  METHODS
  Population cohort study.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  A total of 1,953,932 term singleton pregnancies selected from a national registry for 1999-2011.
  
  
  METHODS
  None.
  
  
  METHODS
  Primary outcome Apgar score <4; secondary outcomes Apgar score <7, intrauterine fetal death, perinatal mortality, congenital anomalies, small for gestational age, asphyxia related morbidity, and cesarean delivery.
  
  
  RESULTS
  The risks of birth asphyxia and related morbidity were calculated in women who conceived either through MAR or spontaneously (SC), with a subgroup analysis for in vitro fertilization (IVF). An additional propensity score matching analysis was performed with matching on multiple maternal baseline covariates (maternal age, ethnicity, socioeconomic status, parity, year of birth, and preexistent diseases). Each MAR pregnancy was matched to three SC controls. Relative to SC, the MAR singletons had an increased risk of adverse neonatal outcomes including Apgar score <4 (adjusted odds ratio [OR] 1.29; 95% CI, 1.14-1.46) and intrauterine fetal death (adjusted OR 1.61; 95% CI, 1.35-1.91). After propensity score matching, the risk of an Apgar score <4 was comparable between MAR and SC singletons (OR 0.99; 95% CI, 0.87-1.14). Cesarean delivery for both fetal distress and nonprogressive labor occurred more among MAR pregnancies compared with SC pregnancies.
  
  
  CONCLUSIONS
  Term singletons conceived after MAR have an increased risk of morbidity related to birth asphyxia. Because this is mainly due to maternal characteristics, obstetric caregivers should be aware that the increased rates of cesareans reflect the behavior of women and physicians rather than increased perinatal complications.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands; Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: s.ensing@amc.uva.nl.
authors.forename: Sabine
authors.initials: S
authors.lastname: Ensing
authors.affiliation: Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Ameen
authors.initials: A
authors.lastname: Abu-Hanna
authors.affiliation: Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Tessa J
authors.initials: TJ
authors.lastname: Roseboom
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Repping
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Fulco
authors.initials: F
authors.lastname: van der Veen
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands; School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Ben Willem J
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Anita C J
authors.initials: AC
authors.lastname: Ravelli
mesh_terms: D000328:Adult; D001238:Asphyxia Neonatorum / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D054238:Perinatal Mortality / Q000639:trends; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D047928:Premature Birth / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D057216:Propensity Score; D012042:Registries; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects* / Q000639:trends; D012307:Risk Factors
keywords: Birth asphyxia; in vitro fertilization; medically assisted reproduction (MAR); poor neonatal outcome; propensity score matching