INS and diabetes mellitus: At the beginning of pregnancy, the risk factors for severe acute maternal morbidity identified in the multivariate analysis were maternal birth in sub-Saharan Africa (aRR, 1.6, 95% CI, 1.1–2.3), nulliparity (aRR, 1.6, 95% CI, 1.3–2.0), preexisting insulin-treated diabetes (aRR, 2.2, 95% CI, 1.1–4.4), and IVF with either autologous oocytes (aRR, 1.3, 95% CI, 1.0–1.6) or oocyte donation (aRR, 2.0, 95% CI, 1.4–2.8) (Table 2).