Conception via Assisted Reproductive Techniques: an Independent Risk Factor for Poor Perinatal Outcome

Assisted Reproductive Techniques (ART) are well established treatments offered in the sub-fertile couple. As a consequence, obstetricians increasingly have to manage high risk pregnancies without any formal guidelines to follow. We carried out a retrospective cohort study to evaluate the risks of ART using data from 11875 women (11326 spontaneously conceived pregnancies and 549 using ART) in order to propose a policy to better manage them antenatally. Outcome measures included induction of labour, method of and gestation at delivery, gestational diabetes mellitus, and small for gestational age, anal sphincter injury, post-partum haemorrhage and neonatal morbidity and mortality. The ART group had higher rates of gestational diabetes mellitus (18.9% vs 9.4%, P <0.0001), small for gestational age (9.1% vs 5.6%, P=0.001), instrumental delivery (19.6 vs 11.8%, P<0.0001), emergency caesarean section (26.8% vs 15%, P<0.0001) and post-partum haemorrhage >1500mL (6.9% vs 3%, P<0.0001). Lower Apgar scores (2.6% vs 1.4%, P=0.03) and admission to neonatal unit were more likely in the ART group (10.2% vs 5.4%, P<0.0001). Our results suggest that antenatal monitoring for gestational diabetes mellitus and fetal growth, appropriate counselling regarding mode and timing of delivery and active management of 3rd stage of labour, are essential when managing high risk ART pregnancies.