PHILADELPHIA -- Women who reported a history of infertility had higher rates of ectopic pregnancies, miscarriages, and stillbirths, according to a new analysis of data from the Women's Health Initiative.
The findings suggest that women who take longer than 1 year to conceive, despite not using contraception, should be monitored carefully in early pregnancy, Rahi Victory, M.D., said at the annual meeting of the American Society for Reproductive Medicine.
Previous studies have suggested that a history of infertility is associated with adverse obstetrical outcomes; however, these studies have been limited by small numbers, methodologic flaws, and a failure to control for confounding factors, said Dr. Victory, a second-year fellow in the reproductive endocrinology and infertility program at Wayne State University in Detroit.
Dr. Victory and his associates analyzed entry questionnaires from almost 162,000 participants in the Women's Health Initiative. Slightly more than 26,000 of these women reported a history of infertility, defined as taking more than 1 year to conceive. After controlling for multiple confounding variables, the investigators found that, compared with fertile women, women with a history of infertility had more than a twofold increase in risk of ectopic pregnancy (odds ratio [OR] 2.23), a 50% increased risk of miscarriage (OR 1.53), and a slightly increased risk of stillbirth (OR 1.12).
Of the women who reported a history of infertility, almost 20,000 said they had sought physician assistance for the problem. Of these, about 11,000 had been given a diagnosis. Tubal and uterine problems were reported by about 3,800 women, and 3,700 reported male factor infertility. Just under 2,000 reported endometriosis, 1,800 reported hormonal problems, and roughly 2,400 reported idiopathic problems or "other." Compared with fertile women, those with tubal or uterine problems were 2.5 times more likely to have had an ectopic pregnancy, and overweight women were almost 50% more likely (OR 1.48) to have had such a pregnancy. After infertility, diabetes was the strongest predictor of miscarriage (OR 1.49), and diabetes was more strongly linked to stillbirth (OR 1.7) than was infertility.
BY KATE JOHNSON
Montreal Bureau
COPYRIGHT 2004 International Medical News Group
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