(092) Trends in Medically Assisted Reproduction Utilization and Obstetrical as well as Perinatal Outcomes in Quebec between 2005 and 2015 - the Impact of the Universal Access Program: an interrupted time series analysis

Publication Number: 1087

Background: In 08/2010, Quebec granted universal access to medically assisted reproduction (MAR) . MAR includes assisted reproductive technology (ART) (i.e. in vitro fertilization, intrauterine insemination) and ovarian stimulators (OS), which are known to increase obstetrical/perinatal adverse outcomes.

Objectives: We first aimed to describe the trends of adverse perinatal outcomes and MAR use during the active years of the program and 5 years prior. We then aimed to quantify the risk of perinatal outcomes associated with the exposure to MAR.

Methods: We conducted a cohort study in the Quebec Pregnancy Cohort (pregnancies of mothers covered by Quebec’ drug insurance plan 12 months prior to and during pregnancy and their children from 01/1998-12/2015). We included all pregnancies with a conception date between 05/08/2005-15/11/2015. This time-period encompasses the 5 active years of the program (05/08/2010-15/11/2015) and 5 years prior (historical comparator). Prevalence of perinatal outcomes (i.e. multiplicity, prematurity [PTB]) and MAR use were analyzed using an interrupted time series analysis to quantify a level change (LC). To quantify the risk of perinatal outcomes associated with the program and MAR exposure, we calculated crude and adjusted odds ratios (aOR) with 95% confidence intervals (CI) by using generalized estimated equation models. Covariates included maternal sociodemographic, history of pregnancy complications, comorbidities, and concomitant medication use, measured in the year before the 1st day of gestation.

Results: We analyzed 231,219 pregnancies with a conception date between 05/08/2005-15/11/2015. Among liveborn deliveries (n=123,393), we observed a 10-fold increase in multiplicity (LC: 2.4%, p< 0.0001) and an increase in PTB (LC: 0.6%, p< 0.01) pre-during program. MAR utilization progressively increased from 2010-2015 (LC: 3.4%, p< 0.0001). Adjusting for potential confounders, multiplicity increased by 6-fold (aOR 6.09, 95%CI 5.23-7.09, 1,174 exposed cases) pre-during program. MAR significantly increased the risk of multiplicity by 4.7-fold (aOR 4.65, 95%CI 3.84-5.62, 193 exposed cases) compared to spontaneous conception (SC). OS alone increased multiplicity risk (aOR 6.28, 95%CI 4.56-8.64, 58 exposed cases) compared to SC. MAR was associated with an increased risk of PTB among singletons (aOR 1.58, 95%CI 1.36-1.85, 194 exposed cases) but not multiples (aOR 1.36, 95%CI 0.96-1.93, 111 exposed cases) compared to SC.

Conclusions: Our findings show a significant increase of multiplicity during the program, particularly associated with OS, which overall parallels an increased MAR utilization. However, the universal access program had aimed to decrease multiplicity associated with MAR, and their subsequent expenditures.