Association between Age and Miscarriage in an Assisted  Reproductive Technology Population: A 10-Year Cohort Study

Doudou  Zhao; Jie  Chen; Xiayang  Li; Zhaofang Li; Jingchen  Zhang; Caixia  Gao; Wenbo  Hong; Danmeng  Liu; Wenhao  Shi; Juanzi  Shi; Pengfei  Qu

doi:10.18502/ijph.v53i9.16456

Doudou Zhao Translational Medicine Center, Northwest Women’s and Children’s Hospital, Xi’an, Shaanxi, 710061, China
Jie Chen Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, 710061, China
Xiayang Li Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, 710061, China
Zhaofang Li Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, 710061, China
Jingchen Zhang Graduate Department, Xi’an Medical University, Xi’an, Shaanxi, 710021, China
Caixia Gao Graduate Department, Xi’an Medical University, Xi’an, Shaanxi, 710021, China
Wenbo Hong Graduate Department, Xi’an Medical University, Xi’an, Shaanxi, 710021, China
Danmeng Liu Translational Medicine Center, Northwest Women’s and Children’s Hospital, Xi’an, Shaanxi, 710061, China
Wenhao Shi Translational Medicine Center, Northwest Women’s and Children’s Hospital, Xi’an, Shaanxi, 710061, China
Juanzi Shi Translational Medicine Center, Northwest Women’s and Children’s Hospital, Xi’an, Shaanxi, 710061, China
Pengfei Qu Translational Medicine Center, Northwest Women’s and Children’s Hospital, Xi’an, Shaanxi, 710061, China

DOI: https://doi.org/10.18502/ijph.v53i9.16456

Keywords: Advanced age; Miscarriage; Assisted reproductive technology; Cohort study; Chinese population

Abstract

Background: Advanced maternal age decreased success of pregnancy rate in the assisted reproductive technology (ART) treatment. We aimed to investigate the association between age and miscarriages in women who required ART for conception.

Methods: A cohort study was conducted using a 10-year sample of 14,898 pregnancy cycles with ART treatment in Xi’an, China. The effects of women’s age on miscarriage were assessed using Poisson regression models. The threshold effect between age and miscarriage was explored through curve fitting.

Results: Compared with lower than 30 years, the risks of early miscarriage and miscarriage were higher in the older age groups (early miscarriage: [35-37 years: RR=1.48, 95% confidence interval (CI): 1.26 to 1.74; ≥38 years: RR=2.25, 95% CI: 1.87 to 2.72]; miscarriage: [35-37 years: RR=1.45, 95%CI: 1.24 to 1.69; ≥38 years: RR=2.17, 95%CI: 1.82 to 2.60]). The nonlinear relationship between age and early miscarriage and miscarriages were observed. The risk of early miscarriage and miscarriage rapidly increased with age after the turning point (age=33 years) (<33 years: [early miscarriage: RR=1.02, 95% CI: 1.00 to 1.04; miscarriage: RR=1.02, 95% CI: 1.00 to 1.03]; ≥33 years: [early miscarriage: RR=1.11, 95% CI: 1.08 to 1.13; miscarriage: RR=1.10, 95% CI: 1.07 to 1.13]).

Conclusion: Among pregnancy cycles undergoing ART, advanced age is associated with higher risk of early miscarriage and miscarriage, and nonlinear relationship between age and early miscarriage and miscarriage were found. More attention should be paid to the risk of pregnant women with older than 33 years in ART treatment.