Affiliation:
1. Department of Obstetrics and Gynecology, Alpert Medical School, Brown University, Providence, RI
2. Department of Obstetrics and Gynecology, Division of Research, Women and Infants Hospital, Warren Alpert Medical School of Brown University
3. Warren Alpert Medical School of Brown University
4. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, Rhode Island
Abstract
Abstract
Background
To examine the association between maternal education and adverse maternal and neonatal outcomes in women who conceived using assisted conception (AC), which included fertility medications, intrauterine insemination, or in vitro fertilization.
Methods
We conducted a retrospective cohort study utilizing the US Vital Statistics data set on national birth certificates from 2016–2020. Women with live, non-anomalous singletons who conceived using AC and had education status recorded were included. Patients were stratified into two groups: bachelor’s degree or higher, or less than a bachelor’s degree. The primary outcome was a composite of maternal adverse outcomes: intensive care unit (ICU) admission, unplanned hysterectomy, or blood transfusion. The secondary outcome was a composite of neonatal adverse outcomes: neonatal ICU admission, ventilator support, or seizure. Multivariable modified Poisson regression models with robust error variance adjusted for maternal age, race, marital status, prenatal care, smoking during pregnancy, neonatal sex, and birth year estimated the relative risk (RR) of outcomes with a 95% confidence interval (CI).
Results
190,444 patients met the inclusion criteria: 142,943 had a bachelor’s degree or higher and 47,501 were without a bachelor’s degree. Composite maternal adverse outcomes were similar among patients with a bachelor’s degree (10.1 per 1,000 live births) and those without a bachelor’s degree (9.4 per 1,000 live births); ARR 1.05, 95% CI (0.94–1.17). However, composite adverse neonatal outcomes were significantly lower in women with a bachelor’s degree or higher (94.1 per 1,000 live births) compared to women without a bachelor’s degree higher (105.9 per 1,000 live births); ARR 0.91, 95% CI (0.88–0.94).
Conclusions
Our study demonstrated that lower maternal education level was not associated with maternal adverse outcomes in patients who conceived using AC but was associated with increased rates of neonatal adverse outcomes. As access to infertility care increases, patients who conceive with AC may be counseled that education level is not associated with maternal morbidity. Further research into the association between maternal education level and neonatal morbidity is indicated.
Publisher
Research Square Platform LLC
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