Current overview of pregnancy complications and live-birth outcome of assisted reproductive technology in mainland China

Abstract

Objective: To survey the proportion of births born after assisted reproductive technology (ART) and compare the obstetric and prenatal complications between ART and spontaneous pregnancy in women in mainland China.

Design: Retrospective analysis.

Setting: Thirty-nine hospitals.

Patient(s): A total of 112,403 deliveries from 14 provinces and 39 different hospitals composed our retrospective study.

Intervention(s): A multiprovince, hospital-based survey was performed.

Main outcome measure(s): The prevalence of obstetric complications, mode of delivery, and prenatal outcomes were compared between ART and spontaneous pregnancy. For each group, data included singleton and twin deliveries.

Result(s): The proportion of infants born as a result of ART in mainland China was about 1.013% in 2011. The incidence of hypertensive disorder in pregnancy (11.0%, odds ratio [OR], 1.27, 95% confidence interval [CI] 1.04-1.60), premature delivery (27.0%, OR, 4.53, 95% CI 3.91-5.25), gestational diabetes mellitus (15.1%, OR 3.05, 95% CI 2.57-3.60), and placenta previa (4.5%, OR 2.18, 95% CI 1.62-2.94) were markedly increased in women who conceived using ART. The cesarean section rate in the ART pregnancy group was 85.3%, which is significantly higher than spontaneous pregnancies (54.0%). Compared with spontaneous pregnancy, ART pregnancy had a significantly increased incidence of low birth weight babies (29.7%) and birth gestational age of less than 37 weeks (30.0%). Infants conceived by ART have increased low 5-minute Apgar and mortality.

Conclusion(s): This population-based survey demonstrates that the proportion of births from ART in mainland China was about 1.013% in 2011. Multiple gestation is significantly increased in ART pregnancies, relative to spontaneous pregnancies. The increasing incidence and risk of maternal complications in ART pregnancies (e.g., premature delivery, placenta previa, gestational diabetes mellitus) are found in singleton and twin gestations in ART. A higher cesarean section rate, low birth weight infants, and higher infant mortality rate were also observed in ART pregnancies. Our survey provides a comprehensive overview of the prevalence of ART and ART-associated complications in mainland China, and provides insight into attitudes toward ART among the mainland Chinese population.

Keywords: Assisted reproductive technology; live birth; mainland Chinese population; obstetric complications; perinatal outcome.