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Severe Maternal Morbidity by Maternal Fertility Status

Am J Obstet Gynecol; ePub 2018 Oct 12; Luke, et al

The risks of severe maternal morbidity are increased for subfertile and in vitro fertilization (IVF) births, especially in pregnancies that are not from autologous, fresh cycles. Researchers evaluated the risk of severe maternal morbidity by maternal fertility status, and for IVF pregnancies, by oocyte source and embryo state combinations. Women in 8 states who underwent IVF cycles resulting in a live birth during 2004-2013 were linked to their infant’s birth certificates; a 10:1 sample of births from non-IVF deliveries were selected for comparison. Among the findings:

  • The population included 1,477,522 pregnancies (1,346,118 fertile, 11,298 subfertile, 80,254 IVF autologous-fresh, 21,964 IVF autologous-thawed, 13,218 IVF donor-fresh, and 4,670 donor-thawed pregnancies); 1,420,529 singleton, 54,573 twin, and 2,420 triplet pregnancies.
  • Compared to fertile women, subfertile and the 4 groups of IVF-treated women had increased risks for blood transfusion and 3rd or 4th degree perineal laceration.
  • The risk of unplanned hysterectomy and ruptured uterus was also increased for IVF-treated women in the autologous-thawed group.
  • Among women with a prior birth, the risk of blood transfusion after a vaginal birth was increased for subfertile women.


Luke B, Brown MB, Wantman E, et al. Risk of severe maternal morbidity by maternal fertility status: A US study in eight states. [Published online ahead of print October 12, 2018]. Am J Obstet Gynecol. doi:10.1016/j.ajog.2018.10.012.