Risk of poor neonatal outcome at term after medically assisted reproduction A propensity score matched study

Term singletons conceived after medically assisted reproduction have an increased risk of morbidity related to birth asphyxia.


Sabine Ensing, M.D., Ameen Abu-Hanna, Ph.D., Tessa J. Roseboom, Ph.D., Sjoerd Repping, Ph.D., Fulco van der Veen, M.D., Ph.D., Ben Willem J. Mol, M.D., Ph.D., Anita C.J. Ravelli, Ph.D.

Volume 104, Issue 2, Pages 384-390



To study risk of birth asphyxia and related morbidity among term singletons born after medically assisted reproduction (MAR).


Population cohort study.


Not applicable.


A total of 1,953,932 term singleton pregnancies selected from a national registry for 1999–2011.



Main Outcome Measure(s):

Primary outcome Apgar score <4; secondary outcomes Apgar score <7, intrauterine fetal death, perinatal mortality, congenital anomalies, small for gestational age, asphyxia related morbidity, and cesarean delivery.


The risks of birth asphyxia and related morbidity were calculated in women who conceived either through MAR or spontaneously (SC), with a subgroup analysis for in vitro fertilization (IVF). An additional propensity score matching analysis was performed with matching on multiple maternal baseline covariates (maternal age, ethnicity, socioeconomic status, parity, year of birth, and preexistent diseases). Each MAR pregnancy was matched to three SC controls. Relative to SC, the MAR singletons had an increased risk of adverse neonatal outcomes including Apgar score


Term singletons conceived after MAR have an increased risk of morbidity related to birth asphyxia. Because this is mainly due to maternal characteristics, obstetric caregivers should be aware that the increased rates of cesareans reflect the behavior of women and physicians rather than increased perinatal complications.

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