title: Impact of fertility treatment on severe maternal morbidity.
abstract: OBJECTIVE
  To determine if fertility treatment is associated with increased risk of severe maternal morbidity (SMM) compared with spontaneous pregnancies.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  In 2012, 6,543 women delivered live births >20 weeks gestation at our center. Women were categorized based on mode of conception: in vitro fertilization (IVF), non-IVF fertility treatment (NIFT), or spontaneous pregnancies.
  
  
  METHODS
  None.
  
  
  METHODS
  The main outcome was presence of true SMM, such as eclampsia, respiratory failure, and peripartum hysterectomy. Deliveries were screened with the use of: 1) International Classification of Diseases 9 codes; 2) prolonged postpartum stay; 3) maternal intensive care unit admissions, and 4) blood transfusion. The charts of women meeting the screening criteria were reviewed to identify true SMM based on a previously validated method, recognizing that medical record review is the criterion standard.
  
  
  RESULTS
  Of the 6,543 deliveries, 246 (3.8%) were IVF conceptions and 109 (1.7%) NIFT conceptions. Sixty-nine cases of true SMM were identified (1.1%). In multivariate analyses, any fertility treatment (IVF + NIFT) was associated with increased risk of SMM compared with spontaneous conceptions. In a subset analysis of singletons only, the association between any fertility treatment (IVF + NIFT) and SMM was not statistically significant.
  
  
  CONCLUSIONS
  Overall, fertility treatment increased risk for SMM events. Given the limited sample size, the negative finding with singleton gestations is inconclusive. Larger multicenter studies with accurate documentation of fertility treatment and SMM cases are needed to further clarify the risk associated with singletons.
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: erica.wang@cshs.org.
authors.forename: Erica T
authors.initials: ET
authors.lastname: Wang
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: John A
authors.initials: JA
authors.lastname: Ozimek
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Naomi
authors.initials: N
authors.lastname: Greene
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Lauren
authors.initials: L
authors.lastname: Ramos
authors.affiliation: UCLA David Geffen School of Medicine, Los Angeles, California.
authors.forename: Nina
authors.initials: N
authors.lastname: Vyas
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Kilpatrick
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Margareta D
authors.initials: MD
authors.lastname: Pisarska
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro / Q000009:adverse effects; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D050498:Live Birth; D016015:Logistic Models; D008499:Medical Records; D015999:Multivariate Analysis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D018873:Pregnancy Rate; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Fertility; infertility; in vitro fertilization; severe maternal morbidity