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Eliner O, Koren RR, Ram HS, Levi M, Haikin Herzberger E, Wiser A, Miller N. Perinatal Outcomes of Singleton, Twin and Triplet Gestations after Oocyte Donation: A Retrospective, Population-Based Cohort Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:962. [PMID: 39201897 PMCID: PMC11353069 DOI: 10.3390/children11080962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/28/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND/OBJECTIVES Although high live birth rates are associated with oocyte donation (OD), these pregnancies are associated with increased obstetric and perinatal risks. This study evaluated maternal and neonatal risks after OD compared to in vitro fertilization (IVF) with autologous oocytes, and to spontaneous pregnancies (SPs), among singletons, twins and triplets. METHODS A retrospective, large, population-based cohort study was conducted based on electronic data from Maccabi Healthcare Services. A total of 469,134 pregnancies were grouped according to the mode of conception. The main outcome measures were preterm birth (PTB), small for gestational age (SGA) and pregnancy-induced hypertension (PIH). The data were analyzed separately for singletons, twins and triplets. RESULTS The mean maternal age was older in the OD group compared with the IVF and SP groups (singletons: 39.7 ± 4.1 vs. 34.5 ± 4.8 and 31.7 ± 5.3 years; twins: 39 ± 4.6 vs. 32.6 ± 4.4 and 31.2 ± 5.1 years; and triplets: 35.6 ± 2.5 vs. 32 ± 3.9 and 29.7 ± 5 years). The mean gestational age was younger among the OD group compared to the SP group (singletons: 37.5 ± 3 vs. 39 ± 2 p = 0.001, and twins: 35 ± 3 vs. 36 ± 2.5 p = 0.001). Higher rates of PTB < 37, PTB < 34 and PTB < 28 weeks were found among OD singletons. Multivariable logistic regressions for PTB < 37 weeks and SGA in singletons demonstrated that OD and IVF are significant risk factors (OR = 4.1, 95%CI = 3.3-5.2; OR = 4.3, 95%CI = 4.1-4.6; OR = 1.9, 95%CI = 1.3-2.6; OR = 2.2, 95%CI = 2-2.4, respectively). Significantly higher rates of PIH were demonstrated among the OD vs. IVF and SP groups in singleton (4.3% vs. 1.7% and 0.7%) and in twin pregnancies (7.5% vs. 4.3% and 3.4%). CONCLUSIONS OD pregnancies are at increased risk for PTB, SGA and PIH.
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Affiliation(s)
- Or Eliner
- IVF Unit-In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel (A.W.)
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Roni Rahav Koren
- IVF Unit-In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel (A.W.)
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hila Shalev Ram
- IVF Unit-In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel (A.W.)
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Mattan Levi
- IVF Unit-In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel (A.W.)
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Einat Haikin Herzberger
- IVF Unit-In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel (A.W.)
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Amir Wiser
- IVF Unit-In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel (A.W.)
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Netanella Miller
- IVF Unit-In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel (A.W.)
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
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Marleen S, Kodithuwakku W, Nandasena R, Mohideen S, Allotey J, Fernández-García S, Gaetano-Gil A, Ruiz-Calvo G, Aquilina J, Khalil A, Bhide P, Zamora J, Thangaratinam S. Maternal and perinatal outcomes in twin pregnancies following assisted reproduction: a systematic review and meta-analysis involving 802 462 pregnancies. Hum Reprod Update 2024; 30:309-322. [PMID: 38345641 PMCID: PMC11063550 DOI: 10.1093/humupd/dmae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/16/2023] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND ART is associated with higher rates of twin pregnancies than singleton pregnancies. Whether twin pregnancies conceived following ART have additional maternal and neonatal complications compared with non-ART twin pregnancies is not known. OBJECTIVE AND RATIONALE The objective was to quantify the risk of adverse maternal and perinatal outcomes among twin pregnancies conceived following ART compared with non-ART and natural conception. Existing reviews vary in the reported outcomes, with many studies including triplet pregnancies in the study population. Therefore, we aimed to perform an up-to-date review with an in-depth analysis of maternal and perinatal outcomes limited to twin pregnancies. SEARCH METHODS We searched electronic databases MEDLINE and EMBASE from January 1990 to May 2023 without language restrictions. All cohort studies reporting maternal and perinatal outcomes following ART compared with non-ART twin pregnancies and natural conception were included. Case-control studies, case reports, case series, animal studies, and in vitro studies were excluded. The Newcastle-Ottawa Scale was used to assess the methodological quality of the studies. Using random-effects meta-analysis, the estimates were pooled and the findings were reported as odds ratios (OR) with 95% CI. OUTCOMES We included 111 studies (802 462 pregnancies). Twin pregnancies conceived following ART were at higher risk of preterm birth at <34 weeks (OR 1.33, 95% CI 1.14-1.56, 29 studies, I2 = 73%), <37 weeks (OR 1.26, 95% CI 1.19-1.33, 70 studies, I2 = 76%), hypertensive disorders in pregnancy (OR 1.29, 95% CI 1.14-1.46, 59 studies, I2 = 87%), gestational diabetes mellitus (OR 1.61, 95% CI 1.48-1.75, 51 studies, I2 = 65%), and caesarean delivery (OR 1.80, 95% CI 1.65-1.97, 70 studies, I2 = 89%) compared with non-ART twins. The risks for the above maternal outcomes were also increased in the ART group compared with natural conception. Of the perinatal outcomes, ART twins were at significantly increased risk of congenital malformations (OR 1.17, 95% CI 1.05-1.30, 39 studies, I2 = 59%), birthweight discordance (>25% (OR 1.31, 95% CI 1.05-1.63, 7 studies, I2 = 0%)), respiratory distress syndrome (OR 1.32, 95% CI 1.09-1.60, 16 studies, I2 = 61%), and neonatal intensive care unit admission (OR 1.24, 95% CI 1.14-1.35, 32 studies, I2 = 87%) compared with non-ART twins. When comparing ART with natural conception, the risk of respiratory distress syndrome, intensive care admissions, and birthweight discordance >25% was higher among the ART group. Perinatal complications, such as stillbirth (OR 0.83, 95% CI 0.70-0.99, 33 studies, I2 = 49%), small for gestational age <10th centile (OR 0.90, 95% CI 0.85-0.95, 26 studies, I2 = 36%), and twin-twin transfusion syndrome (OR 0.45, 95% CI 0.25-0.82, 9 studies, I2 = 25%), were reduced in twin pregnancies conceived with ART versus those without ART. The above perinatal complications were also fewer amongst the ART group than natural conception. WIDER IMPLICATIONS ART twin pregnancies are associated with higher maternal complications than non-ART pregnancies and natural conception, with varied perinatal outcomes. Women seeking ART should be counselled about the increased risks of ART twin pregnancies and should be closely monitored in pregnancy for complications. We recommend exercising caution when interpreting the study findings owing to the study's limitations.
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Affiliation(s)
- Shemoon Marleen
- Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Obstetrics and Gynaecology, Sri Jayewardenepura Postgraduate Teaching Hospital, Nugegoda, Sri Lanka
| | - Wasana Kodithuwakku
- Institute of Neurology, National Hospital of Sri Lanka, Colombo 10, Sri Lanka
| | - Ruvini Nandasena
- Department of Obstetrics and Gynaecology, Sri Jayewardenepura Postgraduate Teaching Hospital, Nugegoda, Sri Lanka
| | - Shezoon Mohideen
- Department of Obstetrics and Gynaecology, Sri Jayewardenepura Postgraduate Teaching Hospital, Nugegoda, Sri Lanka
| | - John Allotey
- World Health Organization (WHO) Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Silvia Fernández-García
- World Health Organization (WHO) Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Andrea Gaetano-Gil
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (CIBERESP), Madrid, Spain
| | - Gabriel Ruiz-Calvo
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (CIBERESP), Madrid, Spain
| | | | - Asma Khalil
- St George's University Hospitals NHS Foundation Trust, London, UK
- Molecular and Clinical Sciences Research Institute, St George's Medical School, University of London, London, UK
| | - Priya Bhide
- Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Javier Zamora
- World Health Organization (WHO) Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (CIBERESP), Madrid, Spain
| | - Shakila Thangaratinam
- World Health Organization (WHO) Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- NIHR Biomedical Research Centre, Birmingham, UK
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Evidence-Based Pre-Pregnancy Counseling for Oocyte Donation Pregnancies: a Systematic Review and Guide for Physicians. Reprod Sci 2022; 29:3311-3320. [PMID: 34981463 DOI: 10.1007/s43032-021-00821-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 12/05/2021] [Indexed: 12/14/2022]
Abstract
It is well known that oocyte donation (OD) pregnancies are associated with higher complication rates compared to autologous pregnancies. However, evidence-based information for pre-pregnancy counseling designed for health care workers is scarce. Therefore, a systematic literature search was performed to find articles that address pre-pregnancy counseling before OD.A systematic search was conducted in September 2020 in various databases, including PubMed and Embase. Nine (systematic) reviews and meta-analyses were included that reported on pre-pregnancy advice in OD pregnancies.Studies are consistent in documenting a higher risk for hypertensive disorders, cesarean section, preterm birth, postpartum hemorrhage, and low birth weight. Based on these complications, pre-pregnancy advice is mentioned in all included systematic reviews to prevent complications in the next pregnancy. All studies recommend counseling women on the increased risk of complications during OD pregnancy. Other recommendations include the prophylactic use of aspirin in pregnancy and restriction to single embryo transfer. Individualized appropriate surveillance and management strategies should be considered for every patient achieving pregnancy by OD.In conclusion, we provide a summary of the most important outcomes in OD pregnancies, and thereby offer a guide for pre-pregnancy counseling.
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Vandekerckhove M, Guignard M, Civadier MS, Benachi A, Bouyer J. Impact of maternal age on obstetric and neonatal morbidity: a retrospective cohort study. BMC Pregnancy Childbirth 2021; 21:732. [PMID: 34711168 PMCID: PMC8555100 DOI: 10.1186/s12884-021-04177-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pregnancies in women over 35 years of age are becoming more frequent. The majority of studies point to an age of 35 as a provider of obstetric and neonatal complications. But several confounding factors are not taken into account and this results in contradictory results. METHODS The objective was to quantify the strength of the association between maternal age and obstetric and neonatal morbidity. This observational study was based on systematic records of 9 years of pregnancies managed in the Obstetrics and Gynaecology Department of Antoine Béclère Hospital, Clamart, France. In all, 24,674 pregnancies were managed at Antoine Béclère Hospital between April 1, 2007 and December 31, 2015, including 23,291 singleton pregnancies. Maternal age was the age at the beginning of pregnancy, taken as a quantitative variable. The main outcome measure was a composite "unfavourable" pregnancy outcome that included miscarriage, induced abortion, in utero foetal death, stillborn or newborn infant weighing under 500 g or delivered before 24 weeks of gestational age. Obstetric and neonatal morbidity comprised hospitalisation during pregnancy for more than 1 day, pre-eclampsia, gestational diabetes requiring hospitalisation, caesarean delivery, preterm birth, small-for-gestational age, and newborn transfer to the paediatric unit or neonatal intensive care unit. RESULTS Analyses were conducted among singleton pregnancies (n = 23,291) and were adjusted for obesity, assisted reproductive technology and geographical origin of the mother. Unfavourable pregnancy outcome rate tripled with age, from 5% among women aged 25 to 34 to 16% among those over 45. Women over 40 were twice as likely to be hospitalised as those aged 25 to 34. The caesarean section rate reached more than 40% among women over 40 and more than 60% in women over 45. The rate of newborn transfer to paediatric intensive care or a neonatal intensive care unit was doubled in women over 40 and small-for-gestational age was more frequent with age, reaching 34% in women over 45. CONCLUSIONS The risk of maternal-foetal complications increases steadily with age and is particularly high after 35 years and closer monitoring appears to be necessary. These results provide additional evidence and information for public health decision-makers.
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Affiliation(s)
- Mélanie Vandekerckhove
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92141, Paris, Clamart, France.
- Université Paris-Saclay, 94807, le Kremlin Bicêtre, France.
| | - Mélanie Guignard
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92141, Paris, Clamart, France
| | - Marie-Sophie Civadier
- Service du département d'informatique médical, AP-HP, Hôpital Antoine Béclère, 92141, Clamart, France
| | - Alexandra Benachi
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92141, Paris, Clamart, France
- Université Paris-Saclay, 94807, le Kremlin Bicêtre, France
| | - Jean Bouyer
- Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France
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Boria F, de la Calle M, Cuerva M, Sainz A, Bartha JL. Impact of oocyte donation on obstetric and perinatal complications in twin pregnancies. J Matern Fetal Neonatal Med 2020; 33:1960-1963. [PMID: 30293468 DOI: 10.1080/14767058.2018.1533944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
Abstract
Aim: To evaluate obstetric and perinatal outcomes of twin pregnancies obtained after in vitro fertilization with donated oocytes.Methods: This is a case-control study comparing 50 women with twin pregnancies after oocyte donation (OD) and 50 women after in vitro fertilization with autologous oocytes. Clinical records were reviewed and obstetric and perinatal outcome variables including rates of preeclampsia, gestational diabetes, pregnancy-induced hypertension, preterm delivery, premature rupture of membranes, cesarean delivery, birth weight, Apgar score, pH test were compared.Results: Women in the OD group were significantly older than those in the AO group (mean 40.8 versus 36 years old, p < .001). There were a higher risk of preeclampsia (OD 24% versus AO 8%), cesarean delivery (OD 90% versus AO 66%), and preterm birth before 37 weeks (OD 52% versus AO 32%). After adjustment for maternal age, only the risk of preterm birth remained significantly higher (OR 3.2 (1.15-8.86); p = .025). Comparing neonatal outcomes, there were no differences in birth weight, pH or Apgar score at birth.Conclusions: Twin pregnancies after OD are associated with a higher risk of preterm birth before 37 weeks of gestation. However, this did not translate into increased rate of adverse perinatal outcomes.
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Affiliation(s)
- Felix Boria
- Hospital Universitario La Paz, Madrid, Spain
| | | | - Marcos Cuerva
- Department of Obstetrics, Quiron San Jose Hospital, Madrid, Spain
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Korb D, Schmitz T, Seco A, Goffinet F, Deneux-Tharaux C. Risk factors and high-risk subgroups of severe acute maternal morbidity in twin pregnancy: A population-based study. PLoS One 2020; 15:e0229612. [PMID: 32109258 PMCID: PMC7048407 DOI: 10.1371/journal.pone.0229612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/10/2020] [Indexed: 11/19/2022] Open
Abstract
Objective To determine risk factors of severe acute maternal morbidity in women with twin pregnancies and identify subgroups at high risk. Methods In a prospective, population-based study of twin deliveries, the JUMODA cohort, all women with twin pregnancies at or after 22 weeks of gestation were recruited in 176 French hospitals. Severe acute maternal morbidity was a composite criterion. We determined its risk factors by multilevel multivariate Poisson regression modeling and identified high-risk subgroups by classification and regression tree (CART) analysis, in two steps: first considering only characteristics known at the beginning of pregnancy and then adding factors arising during its course. Results Among the 8,823 women with twin pregnancies, 542 (6.1%, 95% confidence interval (CI) 5.6–6.6) developed severe acute maternal morbidity. Risk factors for severe maternal morbidity identified at the beginning of pregnancy were maternal birth in sub-Saharan Africa (adjusted relative risk (aRR) 1.6, 95% CI 1.1–2.3), preexisting insulin-treated diabetes (aRR 2.2, 95% CI 1.1–4.4), nulliparity (aRR 1.6, 95% CI 1.3–2.0), IVF with autologous oocytes (aRR, 1.3, 95% CI, 1.0–1.6), and oocyte donation (aRR 2.0, 95% CI 1.4–2.8); CART analysis identified nulliparous women with oocyte donation as the subgroup at highest risk (SAMM rate: 14.7%, 95% CI, 10.3–19.1). At the end of pregnancy, additional risk factors identified were placenta praevia (aRR 3.5, 95% CI 2.3–5.3), non-severe preeclampsia (aRR 2.5, 95% CI 1.9–3.2), and macrosomia for either twin (aRR 1.7, 95% CI 1.3–2.1); CART analysis identified women with both oocyte donation and non-severe preeclampsia (SAMM rate: 28.9%, 95% CI, 19.9–37.9) and sub-Saharan nulliparous women with non-severe preeclampsia (SAMM rate: 26.9%, 95% CI, 9.9–43.9) as the two subgroups at highest risk. Conclusion In woman with twin pregnancy, rates of severe acute maternal morbidity vary between subgroups from 4.6% to 14.7% and from 3.8% to 28.9% at the beginning and at the end of pregnancy respectively, depending on the combined presence of risk factors.
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Affiliation(s)
- Diane Korb
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
- Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France
- * E-mail:
| | - Thomas Schmitz
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
- Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France
| | - Aurélien Seco
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
- Clinical Research Unit of Paris Descartes Necker Cochin, APHP, Paris, France
| | - François Goffinet
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
- Port-Royal Maternity Unit, Cochin Hospital, APHP, Paris, France
| | - Catherine Deneux-Tharaux
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
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Almasi-Hashiani A, Omani-Samani R, Mohammadi M, Amini P, Navid B, Alizadeh A, Khedmati Morasae E, Maroufizadeh S. Assisted reproductive technology and the risk of preeclampsia: an updated systematic review and meta-analysis. BMC Pregnancy Childbirth 2019; 19:149. [PMID: 31046710 PMCID: PMC6498659 DOI: 10.1186/s12884-019-2291-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/12/2019] [Indexed: 11/22/2022] Open
Abstract
Background The objective of this systematic review and meta-analyses was to assess the risk of preeclampsia among women who conceived with assisted reproductive technology (ART). Methods We searched the ISI Web of Knowledge, Medline/PubMed, Scopus, and Embase (from inception to May 2017) for English language articles using a list of key words. In addition, reference lists from identified studies and relevant review articles were also searched. Data extraction was performed by two authors, and the study quality was assessed using the Newcastle–Ottawa Scale. Random-effects model meta-analysis was applied to pool the relative risks (RR) across studies. Results A total of 48 studies (5 case-control studies and 43 cohort studies) were included in this meta-analysis. The Cochran Q test and I2 statistics revealed substantial heterogeneity (Q = 26,313.92, d.f. = 47, p < 0.001 and I2 = 99.8%). Meta-analysis showed a significant increase in preeclampsia in women who conceived by ART compared with those who conceived spontaneously (RR = 1.71, 95% CI = 1.11–2.62, p = 0.015). Conclusions The findings of this systematic review indicate that the use of ART treatment is associated with a 1.71-fold increase in preeclampsia.
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Affiliation(s)
- Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Reza Omani-Samani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Maryam Mohammadi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Payam Amini
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Behnaz Navid
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ahad Alizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Esmaeil Khedmati Morasae
- Institute of Psychology, Health, and Society, Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Saman Maroufizadeh
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
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Obstetric Complications of Donor Egg Conception Pregnancies. J Obstet Gynaecol India 2019; 69:395-398. [PMID: 31598040 DOI: 10.1007/s13224-019-01211-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 02/20/2019] [Indexed: 10/27/2022] Open
Abstract
Ovum donation (OD) pregnancies are becoming increasingly common. Obstetric complications with IVF pregnancies are well documented. However, until recently OD had not previously been investigated as a separate subtype of this. It could be postulated that there may be more complications with OD pregnancies as the embryo is immunologically different to the mother. The subsequent allograft reactions can cause problems with placental development and function leading to pathology. Initial studies investigating OD pregnancies were inadequate due to small sample size and inappropriate control groups. Studies specifically comparing to spontaneous pregnancies alone are not suitable when we already know that IVF in itself increases the risk to both mother and baby. Recent research has optimised the control group by using women undergoing IVF with autologous ovum. Ovum donation has now been shown to be an independent risk factor for hypertensive disease in pregnancy, post-partum haemorrhage and increased risk of caesarean section. Neonatal outcomes are less clear-cut, although there is some evidence to suggest there is increased risk of small for gestational age babies and preterm delivery. It is now clear that OD pregnancies are higher risk than IVF pregnancies with autologous ovum and they should be treated as such. Women with ovum donation pregnancies should have obstetric-led care, in a unit which has ready access to both blood transfusion and cell salvage. Future research should investigate how to reduce the risk of ovum donation to these women.
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Le Ray C, Pelage L, Seco A, Bouvier-Colle MH, Chantry AA, Deneux-Tharaux C. Risk of severe maternal morbidity associated with in vitro fertilisation: a population-based study. BJOG 2019; 126:1033-1041. [PMID: 30801948 DOI: 10.1111/1471-0528.15668] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the association between in vitro fertilisation IVF and severe maternal morbidity (SMM) and to explore the role of multiple pregnancy as an intermediate factor. DESIGN Population-based cohort-nested case-control study. SETTING Six French regions in 2012/13. POPULATION Cases were 2540 women with SMM according to the EPIMOMS definition; controls were 3651 randomly selected women who gave birth without SMM. METHODS Analysis of the associations between IVF and SMM with multivariable logistic regression models, differentiating IVF with autologous oocytes (IVF-AO) from IVF with oocyte donation (IVF-OD). The contribution of multiple pregnancy as an intermediate factor was assessed by path analysis. MAIN OUTCOME MEASURES Severe maternal morbidity overall and SMM according to its main underlying causal condition and by severity (near misses). RESULTS The risk of SMM was significantly higher in women with IVF (adjusted OR = 2.5, 95% CI 1.8-3.3). The risk of SMM was significantly higher with IVF-AO, for all-cause SMM (aOR = 2.0, 95% CI 1.5-2.7), for near misses (aOR = 1.9, 95% CI 1.3-2.8), and for intra/postpartum haemorrhages (aOR = 2.3, 95% CI 1.6-3.2). The risk of SMM was significantly higher with IVF-OD, for all-cause SMM (aOR = 18.6, 95% CI 4.4-78.5), for near misses (aOR = 18.1, 95% CI 4.0-82.3), for SMM due to hypertensive disorders (aOR = 16.7, 95% CI 3.3-85.4) and due to intra/postpartum haemorrhages (aOR = 18.0, 95% CI 4.2-77.8). Path-analysis estimated that 21.6% (95% CI 10.1-33.0) of the risk associated with IVF-OD was mediated by multiple pregnancy, and 49.6% (95% CI 24.0-75.1) of the SMM risk associated with IVF-AO. CONCLUSION The risk of SMM is higher in IVF pregnancies after adjustment for confounders. Exploratory results suggest higher risks among women with IVF-OD; however, confidence intervals were wide, so this finding needs to be confirmed. A large part of the association between IVF-AO and SMM appears to be mediated by multiple pregnancy. TWEETABLE ABSTRACT The risk of severe maternal morbidity is higher in IVF-conceived pregnancies than in pregnancies conceived by other means.
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Affiliation(s)
- C Le Ray
- Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Port Royal Maternity Unit, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, DHU Risks and Pregnancy, Paris Descartes University, Paris, France
| | - L Pelage
- Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Obstetrics and Gynaecology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France
| | - A Seco
- Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,URC-CIC Paris Descartes Necker/Cochin, AP-HP, Cochin Hospital, Paris, France
| | - M-H Bouvier-Colle
- Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - A A Chantry
- Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - C Deneux-Tharaux
- Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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10
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Algeri P, Ornaghi S, Vaglio Tessitore I, Brienza L, Cozzolino S, Incerti M, Vergani P. Delivery and feto-neonatal outcomes of diamniotic twin pregnancies in women with no chronic disease or gestational complications: impact of mode of conception. J Matern Fetal Neonatal Med 2019; 33:2081-2088. [PMID: 30348029 DOI: 10.1080/14767058.2018.1540036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: Autologous and heterologous assisted reproductive technology (ART) conceptions have been on the rise for the last few decades and alongside with that have the rate of multiple pregnancies. Multiple gestations are associated with high odds of gestational complications and, in turn, adverse delivery and feto-neonatal outcomes. Whether ART-conception further increases such elevated risk is still debated. ART is more commonly accessed by older women with chronic diseases, which relate to heightened likelihood of complications. We decided to investigate the influence of autologous and heterologous ART conception compared to spontaneous conception on delivery and feto-neonatal outcomes of diamniotic twin pregnancies in a cohort of healthy women with no chronic conditions or gestational complications.Materials and methods: Retrospective cohort study among diamniotic twin pregnancies in mothers without pregestational or gestational disease. Delivery and feto-neonatal outcomes were compared among three groups according to mode of conception: (1) spontaneous conception (SC, referent group, n = 251 pregnancies), (2) autologous ART-conception (A-ART, n = 87), and (3) heterologous ART-conception (H-ART, n = 22).Results: At adjusted analyses, twin pregnancies conceived by A-ART showed a twofold heightened risk of delivery by urgent/emergent cesarean section, as well as four and sevenfold increase in odds of blood loss >1000 and >1500 mL, respectively. H-ART pregnancies were at fivefold higher risk of undergoing prelabor cesarean section compared to SC, whereas no differences were identified for odds of severe post-partum hemorrhage. Also, A-ART and H-ART gestations displayed fetal and neonatal outcomes similar to SC pregnancies when analysis was adjusted for relevant confounding factors.Conclusion: Our results suggest that both A-ART and H-ART conception associate with increased odds of operative delivery among diamniotic twin pregnancies in healthy mothers with no chronic diseases or gestational complications. Also, a higher risk of severe postpartum hemorrhage appears to relate to A-ART independent of mode of delivery and maternal age. Further studies with larger series of uncomplicated twin pregnancies are warranted to improve our understanding of the relationship of ART to adverse delivery outcomes.
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Affiliation(s)
- Paola Algeri
- Department of Obstetrics, Foundation MBBM, Monza, Italy.,University of Milan - Bicocca School of Medicine and Surgery, Monza, Italy
| | - Sara Ornaghi
- Department of Obstetrics, Foundation MBBM, Monza, Italy.,University of Milan - Bicocca School of Medicine and Surgery, Monza, Italy
| | | | | | | | | | - Patrizia Vergani
- Department of Obstetrics, Foundation MBBM, Monza, Italy.,University of Milan - Bicocca School of Medicine and Surgery, Monza, Italy
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11
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Omani-Samani R, Alizadeh A, Almasi-Hashiani A, Mohammadi M, Maroufizadeh S, Navid B, Khedmati Morasae E, Amini P. Risk of preeclampsia following assisted reproductive technology: systematic review and meta-analysis of 72 cohort studies. J Matern Fetal Neonatal Med 2019; 33:2826-2840. [PMID: 30563382 DOI: 10.1080/14767058.2018.1560406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Previous studies have indicated that women with assisted reproductive technology (ART) pregnancy have an increased risk of preeclampsia. The aim of this current study was to estimate, through a systematic review and meta-analysis of cohort studies, the risk of preeclampsia in women who conceived with ART.Materials and methods: We searched ISI Web of Knowledge, Medline/PubMed, Scopus and Embase up to August 2017 for English-language articles pertaining to risk of preeclampsia in ART pregnancy using standard keywords. Data extraction was conducted by two authors and quality of the studies was assessed using the Newcastle-Ottawa Scale. A random-effects model was used for the meta-analysis.Results: In total, 72 cohort studies (n = 164 870) were included. The results of Cochran test and I2 statistic indicated considerable heterogeneity among studies (Q = 15 415.61, df = 71, p < .001, I2=99.5%). The pooled estimate of preeclampsia risk using the random effects model was 10.8% (95% CI: 9.10-12.5). Furthermore, the funnel plot and Begg's test showed evidence of publication bias.Conclusions: We found that the risk of preeclampsia was very high among women who conceived with ART. Women should be counseled carefully before undergoing ART treatment.
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Affiliation(s)
- Reza Omani-Samani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ahad Alizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Maryam Mohammadi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Saman Maroufizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Behnaz Navid
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Esmaeil Khedmati Morasae
- Department of Health Services Research, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC), Institute of Psychology, Health, and Society, University of Liverpool, Liverpool, UK
| | - Payam Amini
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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12
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Outcomes of singleton versus twin pregnancies in the fifth and sixth decades. Eur J Obstet Gynecol Reprod Biol 2018; 231:255-261. [PMID: 30445376 DOI: 10.1016/j.ejogrb.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pregnancies in the fifth and sixth decades of life have been increasing, but current data are limited regarding the outcomes of twin compared with singleton pregnancies in this age group and to twin pregnancies at younger age. OBJECTIVE To compare obstetrical and neonatal outcomes of IVF conceived pregnancies, in twin gestations of women who were ≥45 years old at delivery to singletons at similar age and twin gestations at the age of <35 years, and to assess if the complications are mainly influenced by the very advanced maternal age or by the multifetal pregnancy. STUDY DESIGN A retrospective cohort study from a single tertiary medical center of women aged ≥45 at delivery between March 2011 and January 2018 and women aged <35 at delivery with twin pregnancies that conceived by IVF. Exclusion criteria were spontaneous pregnancies or pregnancies after ovulation induction, monochorionic twin pregnancies, higher order multiple gestations, or women that underwent fetal reduction. Pregnancy, delivery, postpartum and neonatal outcomes were compared between singleton and twin pregnancies. Multivariate logistic regression was used to evaluate the association between twin pregnancies and adverse outcomes. RESULTS Out of 67,355 deliveries, 612 were of women ≥45 years old, of whom 492 women conceived via IVF (395 singleton and 97 twin pregnancies). Of those, 60 women were ≥50 years old, 49 of them carried singleton and 11 carried twin pregnancies. Baseline characteristics were similar between groups. Women at the fifth and sixth decades with twins had significantly higher rates of preeclampsia (32.0% vs. 10.9%, p < 0.001), gestational diabetes mellitus (35.4% vs. 23.8%, p = 0.020), preterm deliveries <32 weeks of gestation (8.2% vs. 1.3%, p = 0.001), and fetal growth restriction (18.6% vs. 7.6%, p = 0.001) compared with singleton pregnancies at similar maternal age. After multivariate analysis adjusting for confounders, the odds ratio for the composite of preeclampsia, gestational hypertension, intrauterine fetal growth restriction, and placental abruption was 3.19 for twin compared with singleton pregnancies and 1.73 for gestational diabetes mellitus. Pregnancy complications among older women with twins were also significantly higher when compared with younger women with twins (<35 years old). Women in the fifth and sixth decades with twins had higher rates of cesarean deliveries (91.8% vs. 56.4%, p<0.001), gestational hypertension, preeclampsia, and gestational diabetes mellitus (10.3% vs. 4.2%., p=0.016; 32.0% vs. 6.2%, p<0.001; 35.1% vs. 8.1%, p<0.001, respectively) than the younger group carrying twins. CONCLUSIONS Twin pregnancies in the fifth and sixth decades carry significantly higher complications rate compared with singleton pregnancies at the same age and twin pregnancies at younger age.
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