Hospitalizations up to 8 years following delivery in assisted reproductive technology-treated and subfertile women

Objective: To investigate hospitalizations up to 8 years after live birth among women who used assisted reproductive technology (ART) or who were subfertile compared with women who conceived naturally. Design: Retrospective cohort. Setting: Deliveries among privately insured women aged ≥18 years between 2004 and 2017 from Massachusetts state vital records were linked to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System and hospital observational/inpatient stays. Patient(s): We compared patients with ART, medically assisted reproduction (MAR), and unassisted subfertile (USF) delivery with those with fertile delivery. Intervention(s): NA. Main Outcome Measure(s): Postdelivery hospitalization information was derived from the International Classification of Diseases codes for discharges and combined by type. The relative risks and 95% confidence intervals (CIs) of hospitalization for up to the first 8 years postdelivery were modeled. Result(s): Among 492,515 deliveries, 5.6% used ART, 1.6% used MAR, and 1.8% were USF. Compared with fertile deliveries, deliveries that used ART or MAR or were USF were more likely to have hospital utilization (inpatient or observational stay) for any reason for up to 8 years of follow-up (USF, adjusted relative risk [aRR], 1.18 [95% CI, 1.12–1.25]; MAR, aRR, 1.20 [1.13–1.27]; and ART, aRR, 1.29 [1.25–1.34]). Assisted reproductive technology deliveries had an increased risk of hospitalization for conditions of the cardiovascular system (aRR, 1.31 [95% CI, 1.20–1.41]), overweight/obesity (aRR, 1.30 [1.17–1.44]), diabetes (aRR, 1.25 [1.05–1.49]), reproductive tract (aRR, 1.62 [1.47–1.79]), digestive tract (aRR, 1.39 [1.30–1.49]), thyroid (aRR, 2.02 [1.80–2.26]), respiratory system (aRR, 1.13 [1.03–1.24]), and cancer (aRR, 1.40 [1.18–1.65]) up to 8 years after delivery. Deliveries with MAR and subfertility had similar patterns of hospitalization as ART deliveries. Conclusion(s): Women who conceived through fertility treatment or experienced subfertility were at increased risk of subsequent hospitalization resulting from a variety of chronic and acute conditions.