AI Article Synopsis
- This study investigates the link between infertility, assisted reproduction, and cervical insufficiency (CI) in women who have never given birth (nulliparous).
- Data was collected from Swedish health registries, analyzing 2,662 cases of CI against a control group of 26,620 non-cases over 21 years.
- The findings indicate that women with infertility and those using fertility treatments face a higher risk of CI, particularly if they have no prior history of miscarriage, which is significant for improving management strategies for preterm births.
Article Abstract
Background: Pregnancies conceived through assisted reproduction have been associated with increased risks of adverse pregnancy and delivery outcomes, including cervical insufficiency (CI). Despite CI being a significant cause of late miscarriage or preterm birth, there are minimal published data on the associations of infertility (with or without fertility treatment) with CI.
Objective: To examine the associations between infertility-assisted reproduction and CI in nulliparous women.
Study Design: This population-based case-control study used data from Swedish national health registers to extract 2662 cases of cervical insufficiency in singleton pregnancies of nulliparous women in the 21-year period (1992-2012). The reference group of 26,620 controls was extracted from the population of non-cases using simple random sampling.
Results: On adjusting for maternal characteristics and medical history, infertility was associated with CI, overall (adjusted odds ratio [aOR] 1.91 [1.53, 2.39]) and in the subgroup of nonusers of fertility treatment, aOR 1.60 (1.21, 2.12), compared to women without infertility. Among women with infertility, pregnancies conceived with the aid of fertility treatment had higher risk of CI than naturally-conceived pregnancies, aOR 1.49 (1.05, 2.10). In the subgroup of women with infertility and no history of miscarriage, the use of fertility treatment was associated with CI, aOR 3.48 (2.02. 5.98). No association was found between fertility treatment and CI in the pregnancies of women with infertility and a history of miscarriage.
Conclusion: From this study, we conclude that CI in nulliparous women is associated with both infertility and its treatment. For infertile women, the risk of CI following fertility treatment was seen only in those with no history of miscarriage, providing crucial information for improving risk assessment and management strategies for preterm birth prevention in populations availing of fertility treatment.
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| http://dx.doi.org/10.1016/j.ajog.2024.10.035 | DOI Listing |
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