title: Trends in Severe Maternal Morbidity After Assisted Reproductive Technology in the United States, 2008-2012.
abstract: OBJECTIVE
  To examine trends in severe maternal morbidity from 2008 to 2012 in delivery and postpartum hospitalizations among pregnancies conceived with or without assisted reproductive technology (ART).
  
  
  METHODS
  In this retrospective cohort study, deliveries were identified in the 2008-2012 Truven Health MarketScan Commercial Claims and Encounters Databases. Severe maternal morbidity was identified using International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes and Current Procedural Terminology codes. Rate of severe maternal morbidity was calculated for ART and non-ART pregnancies. We performed multivariable logistic regression, controlling for maternal characteristics, and calculated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for severe morbidity. Additionally, a propensity score analysis was performed between ART and non-ART deliveries.
  
  
  RESULTS
  Of 1,016,618 deliveries, 14,761 (1.5%) were identified as pregnancies conceived with ART. Blood transfusion was the most common severe morbidity indicator for ART and non-ART pregnancies. For every 10,000 singleton deliveries, there were 273 ART deliveries or postpartum hospitalizations with severe maternal morbidity compared with 126 for non-ART (P<.001). For ART singleton deliveries, the rate of severe morbidity decreased from 369 per 10,000 deliveries in 2008 to 219 per 10,000 deliveries in 2012 (P=.025). Odds of severe morbidity were increased for ART compared with non-ART singletons (adjusted OR 1.84, 95% CI 1.63-2.08). Among multiple gestations, there was no significant difference between ART and non-ART pregnancies (rate of severe morbidity for ART 604/10,000 and non-ART 539/10,000 deliveries, P=.089; adjusted OR 1.04, 95% CI 0.91-1.20). Propensity score matching agreed with these results.
  
  
  CONCLUSIONS
  Singleton pregnancies conceived with ART are at increased risk for severe maternal morbidity; however, the rate has been decreasing since 2008. Multiple gestations have increased risk regardless of ART status.
authors.affiliation: Department of Gynecology and Obstetrics, Emory University, and the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Angela S
authors.initials: AS
authors.lastname: Martin
authors.forename: Michael
authors.initials: M
authors.lastname: Monsour
authors.forename: Dmitry M
authors.initials: DM
authors.lastname: Kissin
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.forename: William M
authors.initials: WM
authors.lastname: Callaghan
authors.forename: Sheree L
authors.initials: SL
authors.lastname: Boulet
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000639:trends; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002585:Cesarean Section; D004211:Disseminated Intravascular Coagulation / Q000453:epidemiology; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology; D008423:Maternal Age; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D010298:Parity; D010359:Patient Readmission / Q000639:trends; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data*; D057216:Propensity Score; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects; D012121:Respiration, Artificial / Q000639:trends; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology