Perinatal Outcomes of In Vitro Fertilization Versus Natural Pregnancy in Very Low Birth Weight Infants

Kyung Suk Baek; Sol Han; Og Hyang Kim; , Ju Sun Heo; Jihyun Jeon

doi:10.14734/PN.2019.30.2.66

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Baek, Han, Kim, Heo, and Jeon: Perinatal Outcomes of In Vitro Fertilization Versus Natural Pregnancy in Very Low Birth Weight Infants

Original Article

Perinatology 2019;30(2):66-70.

Published online: 4 June 2019

DOI: https://doi.org/10.14734/PN.2019.30.2.66

Perinatal Outcomes of In Vitro Fertilization Versus Natural Pregnancy in Very Low Birth Weight Infants

Kyung Suk Baek, MD¹, Sol Han, MD¹, Og Hyang Kim, MD², , Ju Sun Heo, MD¹, Jihyun Jeon, MD^1,

¹Department of Pediatrics, CHA Gangnam Medical Center, CHA

²Department of University, Seoul; Pediatrics, Korea University Anam Hospital, Seoul, Korea

Correspondence to Jihyun Jeon, MD Department of Pediatrics, CHA Gangnam Medical Center, CHA University, 566 Nonhyeon-ro, Gangnam-gu, Seoul 06135, Korea Tel: +82-2-3468-2815 Fax: +82-2-3468-2618 E-mail: goddaugh@chamc.co.kr

Received 17 September 2018 Revised 13 October 2018 Accepted 25 October 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

In vitro fertilization (IVF) pregnancy is increasing. The recent reviews have reported the perinatal outcomes of IVF were preterm birth, low birth weight, small for gestational age, congenital malformations, neurologic disorders and epigenetic defects. We aimed to analyze the perinatal outcomes of IVF compared with natural pregnancy on very low birth weight infants.

Methods

Our study population was derived from Neonatal Intensive Care Unit of the Gangnam CHA Medical Center from 2010 to 2014, consisting of singleton live births in very low birth weight infants. We grouped IVF group (n=24) and control group (natural pregnancy, n=112). We analyzed two groups about maternal characteristics, neonatal characteristics, and outcomes (retinopathy of prematurity [ROP], bronchopulmonary dysplasia [BPD], periventricular leukomalacia [PVL], necrotizing enterocolitis [NEC], death).

Results

Maternal age was significantly older in IVF group (34.9±0.9 vs. 33.0±0.4, P=0.03). The Apgar score 1 minute of the IVF group was significantly lower than control group (4.0±0.3 vs. 4.8±0.2, P=0.03). But there were no other significant differences of neonatal morbidities. In univariate logistic regression analysis with IVF, the odds ratio of maternal age was 1.13 (95% confidence interval: 1.01–1.27, P=0.04). The relative risk of RDS, BPD, PVL, and ROP was increased, but it was not significant in univariate and multivariate logistic regression.

Conclusion

As the maternal age increased, IVF pregnancy was significantly higher. The relative risk of RDS, BPD, PVL, and ROP was high in IVF group, but it was not significant in univariate and multivariate logistic regression.

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Keywords: Infant, very low birth weight, Fertilization in vitro

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Table 1.

Maternal Characteristics and Morbidities between Two Groups

	Control group (n=112)	IVF group (n=24)	P-value
Maternal age (years)	33.0±0.4	34.9±0.9	0.03
PROM (hour)	15.3±3.8	35.2±21.5	NS
Pre-eclampsia (%)	32 (29.0)	6 (26.0)	NS
Chorioamnionitis (%)	39 (46.0)	6 (40.0)	NS
Antenatal corticosteroid (%)	68 (61.0)	17 (81.0)	NS
C-sec (%)	87 (78.0)	17 (71.0)	NS

Abbreviations: IVF, in vitro fertilization; PROM, premature rupture of membrane; NS, non-specific; C-sec, Cesarean section.

Table 2.

Neonatal Characteristics and Outcomes between Two Groups

	Control group (n=112)	IVF group (n=24)	P-value
Gestational age (weeks)	30.4±0.3	29.6±0.6	NS
Birth weight (g)	1,477.4±46.6	1,382.5±1,04.5	NS
Male	63 (56.0)	15 (63.0)	NS
1 min Apgar	4.8±0.2	4.0±0.3	0.04
5 min Apgar	6.3±0.1	6.0±0.3	0.19
Length (cm)	39.8±0.4	38.9±0.1	NS
Head circumference (cm)	28.1±0.3	27.1±0.7	0.13
Hospital duration (day)	47.3±2.0	53.7±5.3	NS
Duration of intubation (day)	8.1±1.2	10.4±2.4	NS
Duration of O₂ treatment (day)	1.6±0.2	1.3±0.4	NS
NEC	11 (10.0)	0 (0)	NS
ROP	8 (7.0)	4 (16.0)	NS
RDS	87 (78.0)	21 (88.0)	NS
PDA	25 (22.0)	5 (21.0)	NS
BPD	21 (19.0)	7 (29.0)	NS
PVL	2 (2.0)	1 (4.0)	NS
Death	2 (2.0)	0 (0)	NS

Values are presented as mean±standard deviation or number (%). Abbreviations: IVF, in vitro fertilization; NS, non-specific; NEC, necrotizing entero- colitis; ROP, retinopathy of prematurity; RDS, respiratory distress syndrome; PDA, patent ductus arteriosus; BPD, bronchopulmonary dysplasia; PVL, periventricular leukomalacia.

Table 3.

Univariate Logistic Regression Analysis with In Vitro Fertilization

	Unadjusted OR	95% CI	P-value
Maternal age*	1.13	1.01–1.27	0.04
† RDS	1.22	0.38–3.94	NS
† BPD	1.78	0.66–4.85	NS
† PVL	2.39	20.21–27.49	NS
† ROP	2.60	0.71–9.47	NS

*Independent variables.

^† Dependent varibles. Abbreviations: OR, odds ratio; CI, confidence interval; RDS, respiratory distress syndrome; NS, non-specific; BPD, bronchopulmonary dysplasia; PVL, periventricular leukomalacia; ROP, retinopathy of prematurity.

Table 4.

Multivariate Logistic Regression Analysis for Perinatal Morbidities

Adjusted variables	RDS		BPD		PVL		ROP
Adjusted variables	OR	P-value	OR	P-value	OR	P-value	OR	P-value
IVF	1.16	NS	0.77	NS	3.93	NS	2.48	NS
Gestational age	0.85	NS	0.75	NS	1.24	NS	0.69	NS
Birth weight	1.00	NS	0.99	0.02	0.99	NS	0.99	NS
1 min Apgar	0.99	NS	1.06	NS	1.36	NS	1.04	NS
PROM	0.99	NS	0.99	NS	0.99	NS	0.98	NS
Pre-eclampsia	0.54	NS	0.32	NS	1.08	NS	0.25	NS

Abbreviations: RDS, respiratory distress syndrome; BPD, bronchopulmonary dysplasia; PVL, periventricular leukomalacia; ROP, retinopathy of prematurity; OR, odds ratio; IVF, in vitro fertilization; NS, non-specific; PROM, premature rupture of membranes.

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