Probability of second live birth after first natural and medically assisted reproduction-mediated live birth: A historical cohort study

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2023-10-09 DOI:10.1111/aogs.14685

Giovanna Esposito, Fabio Parazzini, Paola Viganò, Matteo Franchi, Sonia Cipriani, Francesco Fedele, Giovanni Corrao, Edgardo Somigliana

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Abstract

Introduction

Evidence on the role of medically assisted reproduction (MAR) in achieving the desired number of children is very limited. The aim of the current investigation was to assess the probability and the mode of conception of a second live birth according to the mode of conception of the first one.

Material and methods

This historical cohort study was based on administrative data from regional healthcare databases. Women hospitalized for childbirth in Lombardy between January 1, 2007 and December 31, 2017 were identified. The probability of a second live birth up to 2021 was estimated using the Kaplan–Meier method. We calculated this probability according to the mode of conception of the first birth, and the analysis was also performed in strata of maternal age at first birth. Cox proportional hazards models were fitted to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the association between mode of conception at first live birth and the probability of having a second live birth. Mothers were right-censored if they moved out of the region, died, or did not have a second live birth by the end of follow-up.

Results

We identified 431 333 women who had their first live birth after a natural conception and 16 837 who had their first live birth after MAR. The probability of having a second live birth was 58.6% and 32.1%, respectively in the two groups (HR = 0.68, 95% CI: 0.66–0.70). Considering solely women who naturally conceived their first live birth, the probability to have a second child with MAR was 1.1% and to have a second child naturally 59.3%. The corresponding values were 11.5% and 25.2% in the group of women with a first MAR-mediated live birth.

Conclusions

In our cohort, one woman out of 10 having a first MAR-mediated live birth underwent MAR programs again. Considering women who had a first natural live birth, this proportion was drastically reduced. In the field of MAR, more attention should be given to the capacity of a couple to achieve the number of desired children.

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第一次自然和医学辅助生殖介导的活产后第二次活产的概率：一项历史队列研究。

引言：关于医学辅助生殖在实现所需儿童数量方面的作用的证据非常有限。目前的调查目的是根据第一胎的受孕模式来评估第二胎活产的概率和受孕模式。材料和方法：这项历史队列研究基于地区医疗数据库的管理数据。已确认2007年1月1日至2017年12月31日期间在伦巴第住院分娩的妇女。使用Kaplan-Meier方法估计了到2021年第二次活产的概率。我们根据第一次分娩的受孕模式计算了这一概率，并在第一次分娩时的产妇年龄层中进行了分析。拟合Cox比例风险模型来估计第一次活产时的受孕模式与第二次活产的概率之间的关联的风险比（HR）和95%置信区间（CI）。如果母亲搬出该地区、死亡或在随访结束时没有进行第二次活产，她们会受到正确的审查。结果：我们确定了431 333名自然受孕后首次活产的妇女和16名 837名MAR后首次活产的患者。两组再次活产的概率分别为58.6%和32.1%（HR = 0.68，95%可信区间：0.66-0.70）。仅考虑自然受孕第一次活产的女性，生第二个患有MAR的孩子的概率为1.1%，生第二胎的概率为59.3%。在第一次MAR介导的活产女性组中，相应的数值分别为11.5%和25.2%。结论：在我们的队列中，每10名首次接受MAR介导的活产的女性中就有一名再次接受了MAR计划。考虑到第一次自然活产的妇女，这一比例大幅下降。在MAR领域，应更多地关注夫妇实现所需子女数量的能力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Obstetricia et Gynecologica Scandinavica 医学-妇产科学

CiteScore

8.00

自引率

4.70%

发文量

180

审稿时长

3-6 weeks

期刊介绍： Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.