1. Objectifs

Intentions :
The aim of this study is to assess «the effect of publicly funded ART [assisted reproductive technology] in Quebec on the risk of adverse maternal and infant outcomes.» (p. 220)

2. Méthode

Échantillon/Matériau :
The authors «carried out a pre- and post-comparison study of 597 416 pregnancies conceived between July 2008 and September 2015 in Quebec, Canada. [They] included 14 309 women who conceived by ART and 583 107 who conceived spontaneously and subsequently delivered a live or stillborn infant in hospitals of Quebec. [They] used data compiled in the Maintenance and Use of Data for the Study of Hospital Clientele registry which includes all hospital discharge records in Quebec.» (p. 220)

Type de traitement des données :
Analyse statistique

3. Résumé

«This pre- and post-comparison study suggests that publicly funded ART was associated with improved maternal and infant outcomes in Quebec. Risks of several adverse outcomes, including severe maternal morbidity, preeclampsia, cesarean delivery, multiple birth, preterm birth and severe neonatal morbidity decreased substantially during the program. The risk of gestational diabetes increased after program implementation, suggesting that more women who were older or had comorbidities were able to achieve pregnancy. Overall, the results suggest that publicly funded ART in Quebec led to more singleton live births and improved maternal and infant outcomes.» (p. 222) «In [this] analysis, almost all infant outcomes improved with publicly funded ART. Risks of preterm birth, NICU [neonatal intensive care unit] admission and severe neonatal morbidity decreased by more than 25%. Multiple births decreased even prior to the introduction of publicly funded ART, possibly due to patients who waited for a free single embryo transfer. Maternal outcomes also improved considerably. Risks of preeclampsia fell by 45% and severe maternal morbidity by 36%. When multiple births were excluded, risks of preeclampsia fell by 39% and preterm birth by 15%.» (p. 223)