Medically Assisted Reproduction and the Risk of Adverse Perinatal Outcomes

Over 5 million children have been born through in vitro fertilization (IVF) across the world. IVF is only one of the many methods of assisted reproduction, which can be used to achieve pregnancy in the context of infertility or subfertility. Since the birth of the first IVF child, Louise Brown, in 1978, a number of researchers have started to study the various impacts of the conception through these methods, on both mothers and children. A growing body of evidence suggests that conception through medically assisted reproduction (MAR) is not without risk. Given that MAR is relatively new and that our look back period is short, there is limited evidence on the risks associated to these procedures, both for the mother and the child. In this chapter, we aim to explore the association between MARs and adverse perinatal outcomes specifically. We will first provide you with an overview of the prevalence and trends of use of these methods around the world, and then delve into the associations between MARs and the risk of perinatal outcomes, namely prematurity, being born with low birth weight and/or small for gestational age, and lastly the impact of MARs on cognitive functions including cerebral palsy, behavioral problems, and autism, which are identified later in the child’s life

Maternal Mental Health in Pregnancy and Its Impact on Children’s Cognitive Development at 18 Months, during the COVID-19 Pandemic (CONCEPTION Study)

Background: The COVID-19 pandemic has significantly affected the mental health of pregnant persons. Objective: We aimed to evaluate the impact of maternal mental health and antidepressant use on children’s cognitive development. Methods: We followed a cohort of children born during the COVID-19 pandemic. Maternal mental health was self-reported during pregnancy (Edinburgh Postnatal Depression Scale, General Anxiety Disorder-7, stress levels, and antidepressant use). The child’s cognitive development was measured using the third edition of the Ages & Stages Questionnaires® (ASQ-3) at 18 months. Multivariate multinomial logistic regression models were built to assess the association between in utero exposure to maternal mental health and ASQ-3 domains: communication, gross motor, fine motor, problem-solving, and personal–social. Results: Overall, 472 children were included in our analyses. After adjusting for potential confounders, a need for further assessment in communication (adjusted odds ratio (aOR) 12.2, 95% confidence interval (CI) (1.60;92.4)), and for improvement in gross motricity (aOR 6.33, 95%CI (2.06;19.4)) were associated with in utero anxiety. The need for improvement in fine motricity (aOR 4.11, 95%CI (1.00; 16.90)) was associated with antidepressant exposure. In utero depression was associated with a decrease in the need for improvement in problem solving (aOR 0.48, 95%CI (0.24; 0.98)). Conclusions: During the COVID-19 pandemic, maternal mental health appears to be associated with some aspects of children’s cognitive development

Prevalence and duration of prescribed opioid use during pregnancy: a cohort study from the Quebec Pregnancy Cohort

International audienceBackground: Recent studies show a rapid growth among pregnant women using high potency opioids for common pain management during their pregnancy. No study has examined the duration of treatment among strong opioid users and weak opioid users during pregnancy. We aimed to investigate the prevalence of prescribed opioid use during pregnancy, in Quebec; and to compare the duration of opioid treatment between strong opioid users and weak opioid users. Methods: Using the Quebec Pregnancy Cohort (1998-2015), we included all pregnancies covered by the Quebec Public Prescription Drug Insurance Program. Opioid exposure was defined as filled at least one prescription for any opioid during pregnancy or before pregnancy but with a duration that overlapped the beginning of pregnancy. Prevalence of opioids use was calculated for all pregnancies, according to pregnancy outcome, trimester of exposure, and individual opioids. The duration of opioid use during pregnancy was analyzed according to 8 categories based on cumulative duration (< 90 days vs. ≥90 days), duration of action (short-acting vs. long-acting) and strength of the opioid (weak vs. strong). Results: Of 442,079 eligible pregnancies, 20,921 (4.7%) were exposed to opioids. Among pregnancies ending with deliveries (n = 249,234), 5.4% were exposed to opioids; the prevalence increased by 40.3% from 3.9% in 1998 to 5.5% in 2015, more specifically a significant increase in the second and third trimesters of pregnancy. Weak opioid, codeine was the most commonly dispensed opioid (70% of all dispensed opioids), followed by strong opioid, hydromorphone (11%), morphine (10%), and oxycodone (5%). The prevalence of codeine use decreased by 47% from 4.3% in 2005 to 2.3% in 2015, accompanied by an increased use of strong opioid, morphine (0.029 to 1.41%), hydromorphone (0.115 to 1.08%) and oxycodone (0.022 to 0.44%), from 1998 to 2015. The average durations of opioid exposure were significantly longer among pregnancies exposed to strong opioid as compared to weak opioid regardless of the cumulative duration or duration of action (P < 0.05). Conclusions: Given the differences in the safety profile between strong opioids and the major weak opioid codeine, the increased use of strong opioids during pregnancy with longer treatment duration raises public health concerns

CAMCCO—Quebec, Manitoba, Saskatchewan, and Alberta—Overall prevalence of prematurity, LBW, and multiplicity.

(PDF)</p

Database available in CAMCCO.

(PDF)</p

CAMCCO—Quebec, Manitoba, Saskatchewan, and Alberta—Overall prevalence of categories of prematurity.

Note: Data on preterm births were missing from SK’s birth abstracts for the years 1996–2000.</p

CAMCCO—Quebec, Manitoba, Saskatchewan, and Alberta—Annual rates of major malformations in the first year of life with trends for each province.

Note: Trend comparisons between provinces p < 0.0001.</p

CAMCCO—Quebec, Manitoba, Saskatchewan, and Alberta—Annual rates of prematurity and low birth weight (LBW).

Annual rates of prematurity and LBW during the study period in Quebec, Manitoba, Saskatchewan, and Alberta. Note: Data on preterm births were missing from SK’s birth abstracts for the years 1996–2000; and birthweight was missing for the years 1996–98 for live births.</p

CAMCCO—Linkage procedures within each province.

ICD 9–10: International Classification of Diseases 9th and 10th Revisions; DIN: Drug Identification Number; PIN: Unique Personal Identification number for mothers and children within each province. (PDF)</p

CAMCCO infrastructure.

(PDF)</p