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Galanti F, Riccio S, Giannini A, D'Oria O, Buzzaccarini G, Scudo M, Muzii L, Battaglia FA. Placentation and complications of ART pregnancy. An update on the different possible etiopathogenic mechanisms involved in the development of obstetric complications. J Reprod Immunol 2024; 162:104191. [PMID: 38219630 DOI: 10.1016/j.jri.2023.104191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/25/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Infertile couples' percentage is increasing all over the world, especially in Italy, with high number of children born in our country through assisted reproductive techniques (ART). However, pregnancies obtained by ART have increased potential obstetrical risks which could be caused by fetus-placenta unit development, most of all due to placentation's evolution. These can be reassumed into miscarriage, chromosomal abnormalities, preterm delivery, multiple pregnancy, IUGR, placenta previa, abruptio placentae, preeclampsia and hypertensive disorders, postpartum hemorrhage. METHODS The aim of this article is to evaluate hypothetic mechanism involved in placentation process and in the etiopathology of ART pregnancies disorders, giving an updating overview of different etiopathogenetic pathways and features. On this scenario, we create an updated review about the etiopathogenesis of abnormal placentation in ART pregnancies. RESULTS Several features and different etiopathogenetic characteristic might impact differently such as advanced maternal age, poor ovarian reserve, oocyte quality and causes of subfertility themselves, and the ART techniques itself, as hormonal medical treatments and laboratory techniques such as gamete and embryo laboratory culture, cryopreservation versus fresh ET, number of embryos transferred. CONCLUSION To further explore the molecular mechanisms behind placentation in ART pregnancies, further studies are necessary to gain a better understanding of the various aspects involved, particularly those which are not fully comprehended. This could prove beneficial to clinicians in both ART care and obstetric care, as it could help to stratify obstetrical risk and decrease complications in women undergoing ART, as well as perinatal disorders in their children. Correct placentation is essential for a successful pregnancy for both mother and baby.
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Affiliation(s)
- Francesco Galanti
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Latina, Italy.
| | - Serena Riccio
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Latina, Italy.
| | - Andrea Giannini
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy.
| | - Ottavia D'Oria
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy.
| | - Giovanni Buzzaccarini
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Maria Scudo
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Latina, Italy.
| | - Ludovico Muzii
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Latina, Italy.
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Tabernero Rico PM. Time to pregnancy and perinatal outcomes in a cohort of spontaneous pregnancies. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100793. [PMID: 36402127 DOI: 10.1016/j.srhc.2022.100793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 09/04/2022] [Accepted: 11/01/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Obstetric and perinatal outcomes depend not only on care during pregnancy, as there is an increasing evidence of their relationship with preexisting conditions. Woman's age and time to pregnancy (TTP) have been related to the prognosis in reproductive success, but TTP could influence fetal well-being and newborn. According to the World Health Organization, 48 million couples have subfertility globally. METHODS We analyzed the relationship between TTP and obstetric (premature labor, preeclampsia…), labor (type of delivery, postpartum hemorrhage…), and neonatal outcomes (low birth weight…) in a cohort of 190 spontaneous gestations. Subfertility is a disease defined by the failure to achieve a pregnancy after 12 months of regular unprotected sexual intercourse. RESULTS TTP was >12 months in 23.1 % (95 % CI = 17.57-29.55), however, no correlation was found with the perinatal outcomes (p = 0.24). We observed that 45.2 % of subfertile women had obstetric complications, 13.2 % labor complications, and 34.2 % neonatal complications, whereas non-subfertile women had 29.4 %, 21.0 %, and 21.0 %, respectively. Half of pregnancies have at least one adverse outcome, and obstetric complications were the most frequent. CONCLUSION Subfertility condition may appear in up to a fifth of our couples. Subfertility may behave as a mild risk factor for adverse perinatal outcomes. Obstetric or perinatal complication may be expected in up to half of the cases. Subfertile women ≥ 35 years of age have a 3-fold increase in their risk of having an obstetric complication when compared to non-subfertile women of the same age.
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Affiliation(s)
- Pedro-Manuel Tabernero Rico
- Obstetrics and Gynecology Department, University Hospital of Fuenlabrada, Madrid, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain.
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Yin R, Wang K, Li L, Dang Y, Wang B, Sheng Y, Ma Z, Sun M. Association between first-trimester subchorionic hematoma detected at 6–8 weeks of gestation and pregnancy outcomes after fresh embryo transfers: a propensity score-matching cohort study. Arch Gynecol Obstet 2022; 306:2167-2175. [DOI: 10.1007/s00404-022-06775-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/28/2022] [Indexed: 11/30/2022]
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Chambers GM, Choi SKY, Irvine K, Venetis C, Harris K, Havard A, Norman RJ, Lui K, Ledger W, Jorm LR. A bespoke data linkage of an IVF clinical quality registry to population health datasets; methods and performance. Int J Popul Data Sci 2021; 6:1679. [PMID: 34549093 PMCID: PMC8436881 DOI: 10.23889/ijpds.v6i1.1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction Assisted reproductive technologies (ART), such as in-vitro fertilisation (IVF), have revolutionised the treatment of infertility, with an estimated 8 million babies born worldwide. However, the long-term health outcomes for women and their offspring remain an area of concern. Linking IVF treatment data to long-term health data is the most efficient method for assessing such outcomes. Objectives To describe the creation and performance of a bespoke population-based data linkage of an ART clinical quality registry to state-based and national administrative datasets. Methods The linked dataset was created by deterministically and probabilistically linking the Australia and New Zealand Assisted Reproduction Database (ANZARD) to New South Wales (NSW) and Australian Capital Territory (ACT) administrative datasets (performed by NSW Centre for Health Record Linkage (CHeReL)) and to national claims datasets (performed by Australian Institute of Health and Welfare (AIHW)). The CHeReL’s Master Linkage Key (MLK) was used as a bridge between ANZARD’s partially identifiable patient data (statistical linkage key) and NSW and ACT administrative datasets. CHeReL then provided personal identifiers to the AIHW to obtain national content data. The results of the linkage were reported, and concordance between births recorded in ANZARD and perinatal data collections (PDCs) was evaluated. Results Of the 62,833 women who had ART treatment in NSW or ACT, 60,419 could be linked to the CHeReL MLK (linkage rate: 96.2%). A reconciliation of ANZARD-recorded births among NSW residents found that 94.2% (95% CI: 93.9–94.4%) of births were also recorded in state/territory-based PDCs. A high concordance was found in plurality status and birth outcome ≥99% agreement rate, Cohen’s kappa ranged: 0.78–0.98) between ANZARD and PDCs. Conclusion The data linkage resource demonstrates that high linkage rates can be achieved with partially identifiable data and that a population spine, such as the CHeReL’s MLK, can be successfully used as a bridge between clinical registries and administrative datasets.
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Affiliation(s)
- Georgina M Chambers
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Stephanie K Y Choi
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Katie Irvine
- Centre for Health Record Linkage, Ministry of Health, New South Wales, Australia
| | - Christos Venetis
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Katie Harris
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alys Havard
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Robert J Norman
- The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kei Lui
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - William Ledger
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Uterine transplantation and IVF for congenital or acquired uterine factor infertility: A systematic review of safety and efficacy outcomes in the first 52 recipients. PLoS One 2020; 15:e0232323. [PMID: 32348371 PMCID: PMC7190173 DOI: 10.1371/journal.pone.0232323] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/12/2020] [Indexed: 12/15/2022] Open
Abstract
Uterine transplantation (UTx) associated with IVF restores fertility in women affected by absolute uterine factor infertility (AUFI). Pregnancies achieved both in women undergoing any solid organ transplantation and following IVF are associated with an increased risk of maternal and neonatal complications. This systematic review evaluated this risk in UTx-IVF treated women focusing on the safety and efficacy features of the treatment. Twenty-two studies and three press releases reporting on 52 UTx-IVF treatments were identified. Regarding the safety of treatment, 38/52 (73,1%) of surgical procedures led to the restoration of uterine function in recipients, 12/52 (23,1%) of recipients experienced post-operative complications requiring hysterectomy, and 2/52 (3,8%) of procedures failed before uterine recipients’ surgery due to intra-operative complications. Regarding the efficacy of treatment, results focused on transplanted patients showing full recovery of organ functioning: 16/38 (42,1%) of patients achieved a pregnancy, including two women who gave births twice. UTx-IVF pregnancies led to 16 deliveries and all new-borns were healthy. Six out of 16 (37,5%) UTx pregnancies faced major complications during gestation. Preterm births occurred in 10/16 (62,5%) UTx deliveries. Our data indicates that the risk of gestational and delivery complications deserves important consideration in AUFI women receiving UTx-IVF treatments. However, these observations are preliminary and need to be revised after larger series of data are published.
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In vitro fertilization is associated with the onset and progression of preeclampsia. Placenta 2019; 89:50-57. [PMID: 31675490 DOI: 10.1016/j.placenta.2019.09.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/16/2019] [Accepted: 09/22/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We aimed to estimate the risk of preeclampsia (PE) associated with in vitro fertilization (IVF) and potential predisposing factors responsible for the observed association. METHODS This retrospective cohort study included 114485 pregnant women who delivered at the Nanjing Maternity and Child Health Care Hospital between 2013 and 2018. Of the 114485 women, 4601 (4%) conceived through IVF (IVF group) and 109884 (96%) conceived spontaneously (SC group). We performed logistic regression analysis to evaluate the risk of PE following IVF compared to spontaneous conception (SC). Then, we used propensity score matching analysis to compare the clinical characteristics and pregnancy outcomes between IVF patients with and without PE. RESULT There were 1339 PE cases in the total study population, with a significantly higher incidence of PE in IVF relative to spontaneous pregnancies (6.1% vs. 1.0%, p < 0.01). Severe PE was more prevalent in singleton IVF-PE group than in singleton SC-PE group (40% vs. 24.1%, p = 0.025). Placenta accreta was more common in singleton preeclamptic patients with IVF than without IVF (12.5vs.2.6%, p = 0.003). Placental hypoxia was more prevalent in twin IVF pregnancies with PE than without PE (6% vs. 12.2%, p = 0.045). Moreover, the IVF-PE group showed more frequent first-trimester bleeding (31.6% vs. 10.5%, p = 0.024) compared to the control group. CONCLUSION IVF is associated with the onset and progression of PE. Defective placentation and placental insufficiency may predispose IVF patients to PE and may manifest as first-trimester bleeding.
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