Varma, T. R., Patel, R. H., & Bhathenia, R. K. (1988). Outcome of pregnancy after infertility. Acta Obstetricia Et Gynecologica Scandinavica, 67(2), 115-119. https://doi.org/10.3109/00016348809004181
Varma TR, Patel RH, Bhathenia RK. Outcome of pregnancy after infertility. Acta Obstet Gynecol Scand. 1988;67(2):115-119. doi:10.3109/00016348809004181
Varma, T. R., et al. "Outcome of pregnancy after infertility." Acta Obstetricia Et Gynecologica Scandinavica, vol. 67, no. 2, 1988, pp. 115-119.
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St. George's Hospital and Medical School, London, England.
More ectopic pregnancy after infertility, same perinatal mortality
Compared with all pregnancies at one hospital, women who got pregnant after infertility had more ectopic pregnancies, multiple pregnancies and pre-existing high blood pressure. Perinatal mortality did not differ. The London study followed 500 of these women and compared them with 7,893 pregnancies.
Key Findings
Ectopic pregnancy occurred in 3.0% of the infertility group and 1.5% of the comparison group. Miscarriage did not differ significantly: 8.0% versus 6.2%.
Pre-existing hypertensive vascular disease affected 7.7% versus 1.5%, and multiple pregnancy 4.1% versus 1.4%, in the infertility group and the comparison group.
Induction of labor was 29.5% versus 17.3%, and elective cesarean section 10.6% versus 5.0%, in the infertility group and the comparison group.
Birth weight below the 10th centile was 12.9% versus 8.6%, and a low Apgar score (0 to 5) 9.5% versus 5.4%, in the infertility group and the comparison group.
Perinatal mortality did not differ between the groups. Delivery before 37 weeks was less common in the infertility group, 6.8% versus 10.0%.
Interpretation
A prospective cohort from one London hospital, 1983 to 1985, shows association within that setting. Only women who conceived are included: 515 women among 748 couples seen, with 500 followed to outcome. The infertility group was older. The authors suggest older age may explain more hypertensive disease. Women received different treatments, and the tests compared the two groups as a whole. The authors propose that intensive antenatal and labor care, under one obstetrician, may explain the similar overall outcomes, an idea the study did not test.
RRM Context
Restorative reproductive medicine sees infertility as a sign of an underlying condition. The paper pools the 500 women followed to outcome and reports no results by cause of infertility. The authors cite earlier work suggesting that birth defects after drug-induced ovulation may trace to the condition behind the infertility. A cause-based evaluation starts by finding that condition.
Our editorial summary of this paper, not the article's abstract.
Abstract
Pregnancy following a period of infertility was considered to be an increased risk for the fetus. During a period of 3 years (1983-85), 748 couples were seen at this infertility clinic; 515 women (68.9%) conceived, and were followed up and studied prospectively. Fifteen of these women moved out of the area. We analysed the results of pregnancies for the remaining 500, (Group 1) and compared them with the outcome for the total obstetric population (Group 2) during the same period. Mean age at conception in the infertility group (Group 1) was 31.8 (+/- 2.7, 2 SD) years, as compared with 23.7 (+/- 2.9, 2 SD) in the total hospital obstetric population (Group 2) (p less than 0.05). The incidences of spontaneous abortion for the two groups (8 and 6.2%) did not differ (p greater than 0.05). However, the incidence of ectopic pregnancy was higher (3.0%) in Group 1 than in Group 2 (1.5%) (p less than 0.01). The incidence of pre-existing hypertensive vascular disease (7.7%) complicating pregnancy and multiple pregnancy (4.1%) was significantly higher in Group 1 than in Group 2 (1.5% and 1.4% respectively), (p less than 0.01). The incidences of induction of labor (29.5%) and elective operative delivery (10.6%) were higher in Group 1 (p less than 0.01). The incidences of infants with birth weight below the tenth centile (12.9%), of fetal distress in labor (14.6%) and a low Apgar score (0-5) (9.5%), were higher in Group 1, but there was no difference in the perinatal mortality rate between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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