Association of assisted reproductive technology with adverse maternal outcome: A cohort study

Background & Objective: To assess the association of assisted reproductive technologies (ART) conception with postpartum hemorrhage (PPH) during the peripartum and postpartum periods. Methods: Clinical records of 11,497 patients enrolled in Fujian Maternity and Child Health Hospital between March 2013 and December 2018 were retrospectively analyzed and divided into the ART group and the natural conception group based on the mode of conception. The incidence of PPH and blood loss at 30, 60, 90, and 120 minutes after delivery were compared. Results: Clinical records of 2527 patients with ART-derived and 78,970 patients with spontaneous pregnancies, who delivered at Fujian Maternity and Child Health Hospital between March 2013 and December 2018, were included. The incidence of PPH (2.53%vs 1.58%, P < 0.001) was greater in the ART group than in the natural conception group. ART was associated with significantly higher rates of PPH both in women who delivered vaginally and by cesarean section (P < 0.001). Similarly, blood loss during the delivery stage was greater in the ART group than in the naturally conceived group, regardless of the mode of delivery (P<0.001). Among women who delivered vaginally, blood loss was greater in the ART group at 30 minutes and 60 minutes after the delivery. However, blood loss at 90 and 120 minutes after the delivery was comparable in all groups, regardless of the mode of delivery. Conclusion: The use of ART was associated with poorer maternal outcomes, including increased incidence of PPH and higher blood loss at 30 and 60 minutes after the delivery.