P-763 Pregnancy complication in women with uterine fibroids (UFs) who conceived spontaneously or with IVF
Notice bibliographique
Résumé
Abstract Study question Both IVF and UFs are risks for pregnancy complications however, does IVF increase complication in women with uterine fibroids, compared to those who conceived spontaneously? Summary answer Women with UFs who conceived with IVF when controlling for confounders had more hypertensive-disorders of pregnancy and gestational-diabetes, while risks of other complications were similar. What is known already Patients with UFs experience reduced fertility rates and increased obstetrical complications compared to patients without fibroids including preterm birth, PPROM, chorioamnionitis, placenta previa, placental abruption, postpartum hemorrhage, fetal malpresentation, intrauterine fetal demise, preeclampsia, eclampsia, chronic hypertension, gestational hypertension, pregnancy induced hypertension and caesarean section. IVF is a risk for hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, caesarean section, post-partum hemorrhage, abnormal placentation, blood transfusion, maternal infection, hysterectomy, small for gestational age infants, intrauterine fetal demise and fetal congenital anomaly. A comparison of the effect of IVF on pregnancy complications in women with fibroids has not been undertaken. Study design, size, duration Retrospective cohort study, using the Healthcare Cost and Utilization Project Nationwide between 2008 until 2014, inclusively, based on International Classification of Diseases, 9 edition, diagnosis (ICD-9). Data was collected from 48 states and the District of Columbia, representing 20% of annual hospital admissions in the United States. Population-based study, including 590 patients with uterine fibroid who conceived with IVF and 60,283 controls with uterine fibroid who conceived spontaneously. Participants/materials, setting, methods Patients with uterine fibroids, female infertility, and treated with IVF (ICD-9 codes 218, 628.9, V26.82) and controls with uterine fibroid who conceived spontaneously. The data was compared using chi-squared tests and multivariate logistic regression was used and adjusted for age, race, income quartiles, smoking, previous caesarean section, chronic and pregnancy induced hypertension, obesity, multiple gestations, pregestational hypertension, gestational diabetes and thyroid disease. Data is expressed as OR and 95% confidence intervals (CI). Main results and the role of chance IVF women were significantly older, with more multiple gestations (27.5% vs. 2.7%; p < 0.0001), and more thyroid disease (15.1% vs. 4.9%; p < 0.0001). After adjustment IVF women had higher risks for pregnancy-induced hypertension (aOR:1.47, 95CI:1.19-1.82; p < 0.001), gestational hypertension (aOR:1.69, 95CI:1.23-2.32; p = 0.001), and gestational diabetes mellitus (aOR:1.41, 95%CI:1.12-1.77; p = 0.004). Although preeclampsia was more frequent in the IVF group (11.5% vs. 6.8%) it missed statistical significance (p = 0.07). There was no statistical differences between rates of wound complication (p = 0.71), placenta previa (p = 0.08), abruptio placenta (p = 0.33), preterm delivery (p = 0.81), Preterm premature rupture of membranes (p = 0.31), chorioamnionitis (p = 0.08), postpartum hemorrhage (p = 0.30), uterine rupture (p = 0.26), hysterectomy (p = 0.95), blood transfusions (p = 0.13), maternal infection (p = 0.08), vaginal delivery (p = 0.11), operative vaginal delivery (p = 0.83), spontaneous vaginal delivery(p = 0.11), small for gestational age infants (p = 0.59), IUFD (p = 0.34) and congenital anomalies (p = 0.48). Limitations, reasons for caution This is a retrospective study of a population database, with possibility for misclassification and other bias. There was a size discrepancy between groups. Wider implications of the findings Although IVF increase risks of GDM and hypertensive disorders of pregnancy possibly due to alternations in placentation, most expected complications induced by IVF use, including maternal and fetal did not occur, possibly influenced by the inherent increased risk already seen in the fibroid uterus. Borderline results should be further investigated. Trial registration number No
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».