{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:37:03Z","timestamp":1790703423998,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,3,27]],"date-time":"2020-03-27T00:00:00Z","timestamp":1585267200000},"content-version":"am","delay-in-days":366,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#am"},{"start":{"date-parts":[[2019,3,27]],"date-time":"2019-03-27T00:00:00Z","timestamp":1553644800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007917","name":"Agricultural Research Service","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007917","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002356","name":"Associa\u00e7\u00e3o Brasileira de Metalurgia, Materiais e Minera\u00e7\u00e3o","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002356","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2019,7]]},"abstract":"Objective<\/jats:title>To investigate the association between in\u00a0vitro fertilisation IVF<\/jats:styled-content> and severe maternal morbidity (SMM<\/jats:styled-content>) and to explore the role of multiple pregnancy as an intermediate factor.<\/jats:p><\/jats:sec>Design<\/jats:title>Population\u2010based cohort\u2010nested case\u2013control study.<\/jats:p><\/jats:sec>Setting<\/jats:title>Six French regions in 2012\/13.<\/jats:p><\/jats:sec>Population<\/jats:title>Cases were 2540 women with SMM<\/jats:styled-content> according to the EPIMOMS<\/jats:styled-content> definition; controls were 3651 randomly selected women who gave birth without SMM<\/jats:styled-content>.<\/jats:p><\/jats:sec>Methods<\/jats:title>Analysis of the associations between IVF<\/jats:styled-content> and SMM<\/jats:styled-content> with multivariable logistic regression models, differentiating IVF<\/jats:styled-content> with autologous oocytes (IVF<\/jats:styled-content>\u2010AO<\/jats:styled-content>) from IVF<\/jats:styled-content> with oocyte donation (IVF<\/jats:styled-content>\u2010OD<\/jats:styled-content>). The contribution of multiple pregnancy as an intermediate factor was assessed by path analysis.<\/jats:p><\/jats:sec>Main outcome measures<\/jats:title>Severe maternal morbidity overall and SMM<\/jats:styled-content> according to its main underlying causal condition and by severity (near misses).<\/jats:p><\/jats:sec>Results<\/jats:title>The risk of SMM<\/jats:styled-content> was significantly higher in women with IVF<\/jats:styled-content> (adjusted OR<\/jats:styled-content>\u00a0=\u00a02.5, 95% CI 1.8\u20133.3). The risk of SMM<\/jats:styled-content> was significantly higher with IVF<\/jats:styled-content>\u2010AO<\/jats:styled-content>, for all\u2010cause SMM<\/jats:styled-content> (aOR<\/jats:styled-content>\u00a0=\u00a02.0, 95% CI 1.5\u20132.7), for near misses (aOR<\/jats:styled-content>\u00a0=\u00a01.9, 95% CI 1.3\u20132.8), and for intra\/postpartum haemorrhages (aOR<\/jats:styled-content>\u00a0=\u00a02.3, 95% CI 1.6\u20133.2). The risk of SMM<\/jats:styled-content> was significantly higher with IVF<\/jats:styled-content>\u2010OD<\/jats:styled-content>, for all\u2010cause SMM<\/jats:styled-content> (aOR<\/jats:styled-content>\u00a0=\u00a018.6, 95% CI 4.4\u201378.5), for near misses (aOR<\/jats:styled-content>\u00a0=\u00a018.1, 95% CI 4.0\u201382.3), for SMM<\/jats:styled-content> due to hypertensive disorders (aOR<\/jats:styled-content>\u00a0=\u00a016.7, 95% CI 3.3\u201385.4) and due to intra\/postpartum haemorrhages (aOR<\/jats:styled-content>\u00a0=\u00a018.0, 95% CI 4.2\u201377.8). Path\u2010analysis estimated that 21.6% (95% CI 10.1\u201333.0) of the risk associated with IVF<\/jats:styled-content>\u2010OD<\/jats:styled-content> was mediated by multiple pregnancy, and 49.6% (95% CI<\/jats:styled-content> 24.0\u201375.1) of the SMM<\/jats:styled-content> risk associated with IVF\u2010AO.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>The risk of SMM<\/jats:styled-content> is higher in IVF<\/jats:styled-content> pregnancies after adjustment for confounders. Exploratory results suggest higher risks among women with IVF<\/jats:styled-content>\u2010OD<\/jats:styled-content>; however, confidence intervals were wide, so this finding needs to be confirmed. A large part of the association between IVF<\/jats:styled-content>\u2010AO<\/jats:styled-content> and SMM<\/jats:styled-content> appears to be mediated by multiple pregnancy.<\/jats:p><\/jats:sec>Tweetable abstract<\/jats:title>The risk of severe maternal morbidity is higher in IVF<\/jats:styled-content>\u2010conceived pregnancies than in pregnancies conceived by other means.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.15668","type":"journal-article","created":{"date-parts":[[2019,2,26]],"date-time":"2019-02-26T05:26:08Z","timestamp":1551158768000},"page":"1033-1041","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Risk of severe maternal morbidity associated with in\u00a0vitro fertilisation: a population\u2010based study"],"prefix":"10.1111","volume":"126","author":[{"given":"C","family":"Le Ray","sequence":"first","affiliation":[{"name":"Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOP\u00e9) Centre for Epidemiology and Statistics Sorbonne Paris Cit\u00e9 DHU Risks in Pregnancy Paris Descartes University Paris France"},{"name":"Port Royal Maternity Unit Cochin Hospital Assistance Publique des H\u00f4pitaux de Paris DHU Risks and Pregnancy Paris Descartes University Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Pelage","sequence":"additional","affiliation":[{"name":"Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOP\u00e9) Centre for Epidemiology and Statistics Sorbonne Paris Cit\u00e9 DHU Risks in Pregnancy Paris Descartes University Paris France"},{"name":"Department of Obstetrics and Gynaecology Groupe Hospitalier Piti\u00e9\u2010Salp\u00eatri\u00e8re Assistance Publique des H\u00f4pitaux de Paris Pierre et Marie Curie University Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Seco","sequence":"additional","affiliation":[{"name":"Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOP\u00e9) Centre for Epidemiology and Statistics Sorbonne Paris Cit\u00e9 DHU Risks in Pregnancy Paris Descartes University Paris France"},{"name":"URC\u2010CIC Paris Descartes Necker\/Cochin AP\u2010HP Cochin Hospital Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u2010H","family":"Bouvier\u2010Colle","sequence":"additional","affiliation":[{"name":"Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOP\u00e9) Centre for Epidemiology and Statistics Sorbonne Paris Cit\u00e9 DHU Risks in Pregnancy Paris Descartes University Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AA","family":"Chantry","sequence":"additional","affiliation":[{"name":"Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOP\u00e9) Centre for Epidemiology and Statistics Sorbonne Paris Cit\u00e9 DHU Risks in Pregnancy Paris Descartes University Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Deneux\u2010Tharaux","sequence":"additional","affiliation":[{"name":"Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOP\u00e9) Centre for Epidemiology and Statistics Sorbonne Paris Cit\u00e9 DHU Risks in Pregnancy Paris Descartes University Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Epimoms Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,3,27]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"2015 Assisted Reproductive Technology National Summary Report. 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