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Folques C, de Sá B, Agostinho M, do Agro J, Martinho A, Rangel G, Marques J, Azevedo J. Combined Neonatal Alloimmune Neutropenia and Thrombocytopenia in Dizygotic Twins Conceived After Oocyte Donation. Cureus 2023; 15:e35950. [PMID: 37050990 PMCID: PMC10085481 DOI: 10.7759/cureus.35950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 04/14/2023] Open
Abstract
Neonatal alloimmune thrombocytopenia (NAIT) and neonatal alloimmune neutropenia (NAIN) may have severe consequences in the neonatal period. We report two dizygotic twins conceived after donated oocytes, suffering NAIT and NAIN in the context of alloantibodies to human platelet antigens (anti-HPA-5b) and human leukocyte antigens (anti-HLA class I). Genotyping demonstrated paternal homozygosity for HPA-5a, while the neonates were heterozygous for HPA-5b.
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Affiliation(s)
- Carolina Folques
- Pediatric Hematology Unit, Department of Clinical Hematology, Hospital and University Centre of Coimbra, Children's Hospital of Coimbra, Coimbra, PRT
- Department of Pediatrics, Leiria Hospital Centre, Leiria, PRT
| | - Beatriz de Sá
- Department of Pediatrics, Leiria Hospital Centre, Leiria, PRT
| | | | - João do Agro
- Department of Pediatrics, Leiria Hospital Centre, Leiria, PRT
| | - António Martinho
- Blood and Transplant Center of Coimbra, Instituto Português do Sangue e Transplantação, Coimbra, PRT
| | - Gabriela Rangel
- Blood and Transplant Center of Porto, Instituto Português do Sangue e Transplantação, Porto, PRT
| | - Joana Marques
- Blood and Transplant Center of Porto, Instituto Português do Sangue e Transplantação, Porto, PRT
| | - Joana Azevedo
- Pediatric Hematology Unit, Department of Clinical Hematology, Hospital and University Centre of Coimbra, Children's Hospital of Coimbra, Coimbra, PRT
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van Bentem K, Bos M, van der Keur C, Kapsenberg H, Lashley E, Eikmans M, van der Hoorn ML. Different immunoregulatory components at the decidua basalis of oocyte donation pregnancies. Hum Immunol 2021; 83:319-327. [PMID: 34785097 DOI: 10.1016/j.humimm.2021.10.008] [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: 08/05/2021] [Revised: 10/08/2021] [Accepted: 10/31/2021] [Indexed: 11/04/2022]
Abstract
Oocyte donation (OD) pregnancies are characterized by more fetal-maternal human leukocyte antigen (HLA) mismatches compared with naturally conceived (NC) and in vitro fertilization (IVF) pregnancies. The maternal immune system has to cope with greater immunogenetic dissimilarity, but involved immunoregulation remains poorly understood. We examined whether the amount of regulatory T cells (Tregs) and immunoregulatory cytokines in decidua basalis of OD pregnancies differs from NC and IVF pregnancies. The cohort included 25 OD, 11 IVF and 16 NC placentas, maternal peripheral blood, and umbilical cord blood of uncomplicated pregnancies. Placenta slides were stained for FOXP3, IL-10, IL-6, gal-1, TGF-β and Flt-1. Semi-quantitative (FOXP3+ Tregs) and computerized analysis (cytokines) were executed. The blood samples were typed for HLA class I and II to calculate fetal-maternal HLA mismatches. The percentage of Tregs was significantly higher in pregnancies with 4-6 HLA class I mismatches (n = 17), compared to 0-3 mismatches (n = 35; p = 0.04). Cytokine analysis showed significant differences between OD, IVF and NC pregnancies. Flt-1 was significantly lower in pregnancies with 4-6 HLA class I mismatches (p = 0.004), and in pregnancies with 6-10 HLA mismatches in total (p = 0.024). This study suggests that immunoregulation at the fetal-maternal interface in OD pregnancies with more fetal-maternal HLA mismatches is altered.
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Affiliation(s)
- Kim van Bentem
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Manon Bos
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands; Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Carin van der Keur
- Department of Immunology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Hanneke Kapsenberg
- Department of Immunology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Eileen Lashley
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Michael Eikmans
- Department of Immunology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Marie-Louise van der Hoorn
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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Tian X, Aiyer KTS, Kapsenberg JM, Roelen DL, van der Hoorn ML, Eikmans M. Uncomplicated oocyte donation pregnancies display an elevated CD163-positive type 2 macrophage load in the decidua, which is associated with fetal-maternal HLA mismatches. Am J Reprod Immunol 2021; 87:e13511. [PMID: 34738274 PMCID: PMC9286476 DOI: 10.1111/aji.13511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/07/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022] Open
Abstract
PROBLEM The embryo of an oocyte donation (OD) pregnancy is completely allogeneic to the mother, which may challenge the maternal immune system to tolerize the fetus. Decidual macrophages are essential in maintaining a healthy pregnancy, and type 2 macrophages may exhibit immune suppressive activity. We hypothesized that the composition of decidual macrophages is different between uncomplicated OD pregnancies and non-OD in vitro fertilization (IVF) pregnancies, and is related to fetal-maternal incompatibility. METHOD OF STUDY Women with uncomplicated pregnancy were enrolled: 25 singleton OD pregnancies and 17 non-OD IVF pregnancies. The extent of immunohistochemical staining of CD14 (pan-macrophage marker) and CD163 (type 2 macrophage marker) in both decidua basalis and parietalis was quantitated by digital image analysis. Maternal and fetal DNA was typed for human leukocyte antigen (HLA)-A, -B, C, -DRB1, and -DQB1, and fetal-maternal HLA mismatches were calculated. RESULTS OD pregnancies showed a higher percentage of CD163+ staining (P = .040) and higher CD163/CD14 ratio (P = .032) in the parietalis than non-OD IVF. The OD group was separated into a semi-allogeneic group (≤5 fetal maternal HLA mismatches) and a fully allogeneic group (> 5 mismatches). The HLA-fully-allogeneic OD group, but not the HLA-semi-allogeneic OD group, showed significantly elevated CD163/CD14 ratio in the parietalis compared with the non-OD IVF group (P < .05). CONCLUSIONS Uncomplicated OD pregnancies display a higher CD163-positive cell fraction in the total decidual macrophage population compared to autologous pregnancies, which may suggest that a local type 2 macrophage-related mechanism is needed to compensate for the higher fetal-maternal HLA mismatch load.
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Affiliation(s)
- Xuezi Tian
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, Netherlands
| | - Kaveri T S Aiyer
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Dave L Roelen
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Michael Eikmans
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
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Korb D, Schmitz T, Seco A, Le Ray C, Santulli P, Goffinet F, Deneux-Tharaux C. Increased risk of severe maternal morbidity in women with twin pregnancies resulting from oocyte donation. Hum Reprod 2021; 35:1922-1932. [PMID: 32644142 DOI: 10.1093/humrep/deaa108] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/21/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is there a difference in the risk of serious maternal complications during pregnancy and the postpartum in twin pregnancies according to mode of conception: natural conception, non-IVF fertility treatment, IVF, ICSI or oocyte donation? SUMMARY ANSWER Women with twin pregnancies after medically assisted reproduction (MAR) had an overall risk of serious maternal complications 30% higher compared with women with natural twin pregnancies, and this association varied according to the MAR procedure; the risk was increased by 50% with IVF using autologous oocytes and by 270% with oocyte donation. WHAT IS KNOWN ALREADY IVF has been reported as a risk factor for serious maternal complications in several concordant studies of singleton pregnancies. For twin pregnancies, this association is less well documented with imprecise categorisation of the mode of conception, and results are contradictory. STUDY DESIGN, SIZE, DURATION This is a secondary analysis of the national, observational, prospective, population-based cohort study of twin pregnancies (JUmeaux Mode d'Accouchement), which took place in France from 10 February 2014 through 1 March 2015. All French maternity units performing more than 1500 annual deliveries were invited to participate, regardless of their academic, public or private status or level of care. Of the 191 eligible units, 176 (92%) participated. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with a twin pregnancy who gave birth at or after 22 weeks of gestation were eligible (N = 8823 women included). We excluded women whose mode of conception was unknown (n = 75). Serious maternal complications were regrouped within the recently emerged concept of severe acute maternal morbidity (SAMM), as a binary composite outcome. The exposure of interest was the mode of conception, studied in five classes: natural conception (reference group), non-IVF fertility treatment including insemination and ovarian stimulation, IVF with autologous oocyte, ICSI with autologous oocyte and oocyte donation. To assess the association between the mode of conception and SAMM, we used multivariate logistic regression to adjust for confounders. Structural equation modelling (SEM) was used to explore the contribution to this association of potential intermediate factors, i.e. factors possibly caused by the mode of conception and responsible for SAMM: non-severe pre-eclampsia, placenta praevia and planned mode of delivery. MAIN RESULTS AND THE ROLE OF CHANCE Among the 8748 women of the study population, 5890 (67.3%) conceived naturally, 854 (9.8%) had non-IVF fertility treatment, 1307 (14.9%) had IVF with autologous oocytes, 368 (4.2%) had ICSI with autologous oocytes and 329 (3.8%) used oocyte donation. Overall, 538 (6.1%) developed SAMM. Women with twin pregnancy after any type of MAR had a higher risk of SAMM than those with a natural twin pregnancy, after adjustment for confounders (7.9% (227/2858) compared to 5.3% (311/5890), adjusted odds ratio (aOR) 1.3, 95% CI 1.1-1.6). This association varied according to the MAR procedure. The risk of SAMM was higher among women with IVF using either autologous oocytes (8.3%; 108/1307) or oocyte donation (14.0%; 46/329) compared with the reference group (respectively aOR 1.5, 95% CI 1.1-1.9 and aOR 2.7, 95% CI 1.8-4.1) and higher after oocyte donation compared with autologous oocytes (aOR 1.7, 95% CI 1.1-2.6). Conversely, the risk of SAMM for women with non-IVF fertility treatment (6.2%; 53/854) and with ICSI using autologous oocytes (5.4%; 20/368) did not differ from that of the reference group (5.3%; 311/5890) (respectively aOR 1.1, 95% CI 0.8-1.5 and aOR 0.9, 95% CI 0.6-1.5). The tested intermediate factors poorly explained these increased risks. LIMITATIONS, REASONS FOR CAUTION Beyond the confounders and intermediate factors considered in our analysis, specific causes of infertility and specific aspects of infertility treatments may explain the differences in the risk of SAMM by mode of conception. However, these data were not available. WIDER IMPLICATIONS OF THE FINDINGS Our study showed an increased risk of SAMM in women with twin pregnancies after MAR, notably after IVF using autologous oocytes and particularly after oocyte donation. To avoid unnecessary exposure to the high-risk combination of MAR and multiple pregnancies, transfer of a single embryo should be encouraged whenever possible. Knowledge of these differential risks may inform discussions between clinicians and women about the mode of conception and help to optimise obstetric care for women in subgroups at higher risk. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a grant from the French Ministry of Health (Programme Hospitalier de Recherche Clinique, AOM2012). There are no competing interests. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Diane Korb
- Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France
| | - Thomas Schmitz
- Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France
| | - Aurélien Seco
- Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Clinical Research Unit of Paris Descartes Necker Cochin, APHP, Paris, France
| | - Camille Le Ray
- Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Maternité Port-Royal, AP-HP, APHP, Centre-Université de Paris, Paris, France
| | - Pietro Santulli
- Department of Obstetrics and Gynecology II and Reproductive Medicine, Cochin Hospital, APHP, Paris, France.,Université de Paris, Paris, France
| | - François Goffinet
- Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Maternité Port-Royal, AP-HP, APHP, Centre-Université de Paris, Paris, France
| | - Catherine Deneux-Tharaux
- Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
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Garcia Castro J, Rodríguez-Pardo J, Díaz de Terán J. Eclampsia-Induced Posterior Reversible Encephalopathy Syndrome in a Donor Oocyte Recipient. J Family Reprod Health 2021; 14:269-272. [PMID: 34054999 PMCID: PMC8144482 DOI: 10.18502/jfrh.v14i4.5211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: Posterior reversible encephalopathy syndrome (PRES) has been robustly associated with preeclampsia, hyperperfusion or endothelial dysfunction suggested as possible mechanisms. In this article, we report an illustrative case of this complication in a patient with risk factors for hypertensive disorders in pregnancy, including advanced maternal age and donor oocyte fertilization. Case report: We present a case of a 40-year-old pregnant, donor oocyte recipient with sudden decreased visual acuity accompanied by hypertension, proteinuria and tonic-clonic seizures. Magnetic resonance imaging (MRI) of the brain showed bilateral lesions in the parieto-occipital regions suggestive of vasogenic edema, leading us to suspect posterior reversible encephalopathy syndrome. The patient underwent an emergency cesarean section and labetalol and magnesium sulfate were administered intravenously. The neurological symptoms and radiological findings resolved following delivery and the patient’s blood pressure normalized, supporting the diagnosis of posterior reversible encephalopathy syndrome. Conclusion: Pregnancy by donor oocyte fertilization may entail a higher risk of eclampsia and associated posterior reversible encephalopathy syndrome.
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Eikmans M, van der Zwan A, Claas FHJ, van der Hoorn ML, Heidt S. Got your mother in a whirl: The role of maternal T cells and myeloid cells in pregnancy. HLA 2020; 96:561-579. [PMID: 32841539 DOI: 10.1111/tan.14055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/09/2020] [Accepted: 07/29/2020] [Indexed: 12/22/2022]
Abstract
Appropriate development of the placenta is required for healthy pregnancy to occur. After implantation of the fertilized blastocyst, fetal trophoblasts invade the endometrium and myometrium of the mother's uterus to establish placentation. In this process, fetal trophoblasts encounter maternal immune cells. In this review, we focus on the role of maternal T cells and myeloid cells (macrophages, dendritic cells) in pregnancy and their interaction with trophoblasts. To retain immunologic tolerization, trophoblasts evade immune recognition by T cells and produce factors that modulate their phenotype and function. On top of that, the local environment at the maternal-fetal interface favors expansion of regulatory T cells. Macrophages and dendritic cells are essential in maintaining a healthy pregnancy. They produce soluble factors and act as antigen-presenting cells, thereby interacting with T cells. Herein, M2 macrophages, immature dendritic cells, CD4+ Th2 cells, and regulatory T cells represent an axis that maintains a local immune tolerant environment. We consider outstanding issues concerning these cell types and their pathways, which need to be addressed in future investigations. Data from recent single-cell sequencing experiments of the placental bed, to study heterogeneity of maternal immune cells and to predict cell-cell interactions, are discussed. Novel ways for long-term culturing of primary trophoblasts allow for cell-cell interaction studies in a functional way. Future directions should include study of the functionality of currently known and newly identified decidual immune cell subsets in healthy and complicated pregnancies, and their interaction with and modulation by trophoblast cells.
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Affiliation(s)
- Michael Eikmans
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anita van der Zwan
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frans H J Claas
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Sebastiaan Heidt
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
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van 't Hof LJ, Dijkstra KL, van der Keur C, Eikmans M, Baelde HJ, Bos M, van der Hoorn MLP. Decreased expression of ligands of placental immune checkpoint inhibitors in uncomplicated and preeclamptic oocyte donation pregnancies. J Reprod Immunol 2020; 142:103194. [PMID: 32979711 DOI: 10.1016/j.jri.2020.103194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/12/2020] [Accepted: 08/26/2020] [Indexed: 12/31/2022]
Abstract
Oocyte donation (OD) pregnancies are characterized by a complete immunogenetic dissimilarity between mother and fetus, which requires enhanced immunoregulation compared to naturally conceived (NC) pregnancies. The trophoblast expresses co-inhibitory ligands crucial for regulation of the maternal T cell response. Therefore, we studied the role of placental immune checkpoint inhibitors for the establishment of fetal tolerance and their relation to the development of preeclampsia in OD compared to NC pregnancies. Placental tissue from uncomplicated OD (n = 21) and NC (n = 21) pregnancies, and OD (n = 9) and NC (n = 15) pregnancies complicated with preeclampsia were studied. Protein expression of co-inhibitory ligands PD-L1 and CD200 was double blind semi-quantitatively determined by immunohistochemistry. Messenger RNA expression of PD-L1, CD200 and indoleamine 2,3-dioxygenase (IDO) was determined using qPCR. Decreased PD-L1 and CD200 protein expression and increased IDO mRNA expression was observed in uncomplicated OD versus NC pregnancies (all p < 0.05). CD200 protein expression was positively correlated with PD-L1 expression in all groups, with the number of HLA total mismatches and with HLA class I mismatches in uncomplicated OD cases (all p < 0.05). Preeclamptic cases showed lower PD-L1 protein and CD200 protein and mRNA expression in OD compared to NC pregnancies (all p < 0.05). This study shows that signaling by co-inhibitory PD-L1 and CD200 and by immunosuppressive IDO is altered in the placenta of OD pregnancies, suggesting a contribution to the higher risk for preeclampsia. These insights provide future prospects in unraveling the immune paradox of oocyte pregnancy, which are applicable for better risk management and treatment of uncomplicated and preeclamptic pregnancies.
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Affiliation(s)
- L J van 't Hof
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - K L Dijkstra
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - C van der Keur
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Eikmans
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - H J Baelde
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Bos
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - M L P van der Hoorn
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
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Savulescu DM, Groome M, Malfeld SCK, Madhi S, Koen A, Jones S, Duxbury V, Scheuermaier K, De Assis Rosa D, Suchard M. HLA antibody repertoire in infants suggests selectivity in transplacental crossing. Am J Reprod Immunol 2020; 84:e13264. [PMID: 32395838 PMCID: PMC7507134 DOI: 10.1111/aji.13264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022] Open
Abstract
PROBLEM Late in pregnancy, women produce and transfer high amounts of antibodies to the foetus. During gestation, women produce antibodies against human leukocyte antigens (HLA), including antibodies directed at foetal HLA. There is paucity of data on transplacental crossing, specificity and role of HLA antibodies in pregnancy and new-borns. METHOD OF STUDY Using highly sensitive Luminex technology, we measured prevalence of IgG HLA antibodies in 30 mother-infant pairs six weeks post-partum. Additionally, in six pregnant women, we measured HLA antibodies longitudinally and HLA-typed infant DNA to assess whether maternal HLA antibodies were directed at infant specificities. RESULTS Overall, 68% of mothers and 44% of infants expressed HLA-I antibodies and 56% of mothers and 52% of infants expressed HLA-II antibodies. Infants shared up to 78% of antibodies with their mothers, suggesting that the remaining antibodies were self-made. Less than 25% of maternal HLA antibodies were detected in infants, possibly due to selection in transplacental crossing. We detected complement-fixing HLA antibodies in mothers and at low levels in infants. In a third of our pregnant subjects, we detected infant-directed HLA antibodies. CONCLUSION Our findings raise the possibility of selection in transplacental crossing of HLA antibodies. As HLA antibodies may act as autoantibodies in the neonate, the mechanism of a selective transfer may give important insights into immune tolerance. Findings also suggest that infants start producing their own HLA antibodies in the first weeks of life, which, together with maternally derived antibodies may impact the infant's immune reaction to HLA proteins.
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Affiliation(s)
- Dana M. Savulescu
- Centre for Vaccines and Immunology (CVI)National Institute for Communicable Diseases (NICD)A Division of the National Health Laboratory ServiceJohannesburgGautengSouth Africa
| | - Michelle Groome
- Medical Research Council: Respiratory and Meningeal Pathogens Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgGautengSouth Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable DiseasesFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgGautengSouth Africa
| | - Susan C. K. Malfeld
- Centre for Vaccines and Immunology (CVI)National Institute for Communicable Diseases (NICD)A Division of the National Health Laboratory ServiceJohannesburgGautengSouth Africa
| | - Shabir Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgGautengSouth Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable DiseasesFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgGautengSouth Africa
| | - Anthonet Koen
- Medical Research Council: Respiratory and Meningeal Pathogens Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgGautengSouth Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable DiseasesFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgGautengSouth Africa
| | - Stephanie Jones
- Medical Research Council: Respiratory and Meningeal Pathogens Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgGautengSouth Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable DiseasesFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgGautengSouth Africa
| | - Vania Duxbury
- Brain Function Research GroupSchool of PhysiologyFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgGautengSouth Africa
| | - Karine Scheuermaier
- Brain Function Research GroupSchool of PhysiologyFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgGautengSouth Africa
| | - Debbie De Assis Rosa
- School of Molecular and Cell BiologyFaculty of ScienceUniversity of the WitwatersrandJohannesburgGautengSouth Africa
| | - Melinda Suchard
- Centre for Vaccines and Immunology (CVI)National Institute for Communicable Diseases (NICD)A Division of the National Health Laboratory ServiceJohannesburgGautengSouth Africa
- Department of Chemical PathologyFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgGautengSouth Africa
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9
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Dondik Y, Pagidas K, Eklund E, Ngo C, Palomaki GE, Lambert-Messerlian G. Levels of angiogenic markers in second-trimester maternal serum from in vitro fertilization pregnancies with oocyte donation. Fertil Steril 2020; 112:1112-1117. [PMID: 31843087 DOI: 10.1016/j.fertnstert.2019.07.017] [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: 03/15/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine whether differences exist in angiogenic placental growth factor (PlGF) and antiangiogenic soluble vascular endothelial growth factor receptor 1 (sVEGFR-1; both being early markers of placental ischemic disease) in oocyte-donation (OD) pregnancies, compared with autologous in vitro fertilization (aIVF) and spontaneous pregnancies. DESIGN Case-control study of residual second-trimester serum samples from women undergoing prenatal screening. SETTING Academic medical center. PATIENT(S) Fifty-seven OD pregnancies were identified. Each OD pregnancy was matched to two spontaneous pregnancies (n = 114) and one aIVF pregnancy (n = 57). INTERVENTIONS(S) None. MAIN OUTCOME MEASURE(S) Second-trimester serum PlGF and sVEGFR-1 levels. RESULT(S) sVEGFR-1, PlGF, and unconjugated E2 levels were similar among the three study groups. The ratio of sVEGFR-1 to PlGF was significantly higher in the OD group. Consistently with previous studies, alpha-fetoprotein (AFP) in the OD group was significantly elevated compared with spontaneous pregnancy. Both aIVF and OD groups had greater levels of inhibin A than the spontaneous pregnancy group, and the OD group had significantly higher levels of inhibin A than the aIVF group. hCG levels were significantly elevated in aIVF compared with spontaneous pregnancy; however, levels were not different between aIVF and OD. CONCLUSION(S) Second-trimester serum sVEGFR-1 and PlGF levels were not significantly altered in OD pregnancies. Our data support previous findings that OD pregnancies have uniquely increased second-trimester AFP, hCG, and inhibin A levels compared with aIVF. However, the biologic basis of these marker elevations in OD may not be related to placental angiogenesis.
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Affiliation(s)
- Yelena Dondik
- University of Louisville School of Medicine, Louisville, Kentucky.
| | - Kelly Pagidas
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Elizabeth Eklund
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Alpert Medical School, Brown University, Providence, Rhode Island
| | - Christina Ngo
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Alpert Medical School, Brown University, Providence, Rhode Island
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Alpert Medical School, Brown University, Providence, Rhode Island
| | - Geralyn Lambert-Messerlian
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Alpert Medical School, Brown University, Providence, Rhode Island
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The development of preeclampsia in oocyte donation pregnancies is related to the number of fetal-maternal HLA class II mismatches. J Reprod Immunol 2019; 137:103074. [PMID: 31864034 DOI: 10.1016/j.jri.2019.103074] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 12/03/2019] [Indexed: 11/24/2022]
Abstract
In oocyte donation (OD) pregnancy, a fetus can be completely allogeneic to the recipient. Consequently, the maternal immune system has to cope with greater immunogenetic dissimilarity compared to naturally conceived pregnancy. Previously, we showed an association between successful OD pregnancy and lower immunogenetic dissimilarity, reflected by the number of fetal-maternal Human Leukocyte Antigen (HLA) mismatches, than expected by chance. In this study we aimed to determine whether the development of preeclampsia in OD pregnancies is related to the number of fetal-maternal HLA mismatches. A retrospective, nested case-control study was performed within a cohort of 76 singleton OD pregnancies. Maternal and fetal umbilical cord blood was typed for HLA-A, -B, -C, -DR and -DQ, and the number of fetal-maternal HLA mismatches was calculated. In addition, the incidence of child-specific HLA antibodies was determined. 13 pregnancies were complicated by preeclampsia. To demonstrate an influence of HLA mismatches on the development of preeclampsia, a univariate logistic regression analysis was performed adjusted for maternal age and socio-economic status. A significant association between the number of fetal-maternal HLA class II mismatches and the development of preeclampsia was observed (OR = 3.8, 95 % CI: 1.6-9.0; p = 0.003). This association was not linked to the development of HLA class II antibodies. According to our findings, an increased number of HLA class II mismatches is a risk factor for the development of preeclampsia in OD pregnancies. The effect of HLA class II mismatches might be explained by the induction of a cellular rather than a humoral immune response.
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van Bentem K, Lashley E, Bos M, Eikmans M, Heidt S, Claas F, le Cessie S, van der Hoorn ML. Relating the number of human leucocytes antigen mismatches to pregnancy complications in oocyte donation pregnancies: study protocol for a prospective multicentre cohort study (DONOR study). BMJ Open 2019; 9:e027469. [PMID: 31345965 PMCID: PMC6661658 DOI: 10.1136/bmjopen-2018-027469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 04/05/2019] [Accepted: 06/18/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Oocyte donation (OD) enables women with reproductive failure to conceive. Compared with naturally conceived (NC) and in vitrofertilisation (IVF) pregnancies, OD pregnancies are associated with a higher risk of pregnancy complications. The allogeneic nature of the fetus in OD pregnancies possibly plays a role in the development of these complications. The objective of the current study is therefore to study the number and nature of human leucocyte antigen (HLA) mismatches between fetus and mother and its association with the development of hypertensive pregnancy complications. METHODS AND ANALYSIS In this prospective multicentre cohort study, 200 patients visiting one of the 11 participating fertility centres in the Netherlands to perform OD or embryo donation or surrogacy will be invited to participate. These patients will be included as the exposed group. In addition, 146 patients with a NC pregnancy and 146 patients who applied for non-donor IVF are included as non-exposed subjects. These groups are frequency matched on age and ethnicity and only singleton pregnancies will be included. The primary clinical outcome of the study is the development of hypertensive disease during pregnancy. Secondary outcomes are the severity of the pre-eclampsia, time to development of pre-eclampsia and development of other pregnancy complications. The association of high number of HLA mismatches (>5) between mother and fetus will be determined and related to clinical outcome and pregnancy complication. ETHICS AND DISSEMINATION This study received ethical approval from the medical ethics committee in the Leiden University Medical Centre, the Netherlands (P16.048, ABR NL56308.058.16). Study findings will be presented at (inter) national conferences and published in peer-reviewed journals.
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Affiliation(s)
- Kim van Bentem
- Department of Gynaecology and Obstetrics, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Eileen Lashley
- Department of Gynaecology and Obstetrics, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Manon Bos
- Department of Gynaecology and Obstetrics, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Michael Eikmans
- Department of Immunohematology and Bloodtransfusion, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Sebastiaan Heidt
- Department of Immunohematology and Bloodtransfusion, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Frans Claas
- Department of Immunohematology and Bloodtransfusion, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
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Giannakou K, Evangelou E, Papatheodorou SI. Genetic and non-genetic risk factors for pre-eclampsia: umbrella review of systematic reviews and meta-analyses of observational studies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:720-730. [PMID: 29143991 DOI: 10.1002/uog.18959] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/09/2017] [Accepted: 10/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To summarize evidence from the literature on genetic and non-genetic risk factors associated with pre-eclampsia (PE), assess the presence of statistical bias in the studies and identify risk factors for which there is robust evidence supporting their association with PE. METHODS PubMed and ISI Web of Science were searched from inception to October 2016, to identify systematic reviews and meta-analyses of observational studies examining associations between genetic or non-genetic risk factors and PE. For each meta-analysis, the summary-effect size was estimated using random-effects and fixed-effects models, along with 95% CIs and the 95% prediction interval. Between-study heterogeneity was expressed using the I2 statistic, and evidence of small-study effects (large studies had significantly more conservative results than smaller studies) and evidence of excess significance bias (too many studies with statistically significant results) were estimated. RESULTS Fifty-eight eligible meta-analyses were identified, which included 1466 primary studies and provided data on 130 comparisons of risk factors associated with PE, covering a wide range of comorbid diseases, genetic factors, exposure to environmental agents and biomarkers. Sixty-five (50%) associations had nominally statistically significant findings at P < 0.05, while 16 (12%) were significant at P < 10-6 . Sixty-five (50%) associations had large or very large heterogeneity. Evidence for small-study effects and excess significance bias was found in 10 (8%) and 26 (20%) associations, respectively. The only non-genetic risk factor with convincing evidence for an association with PE was oocyte donation vs spontaneous conception, which had a summary odds ratio of 4.33 (95% CI, 3.11-6.03), was supported by 2712 cases with small heterogeneity (I2 = 26%) and 95% prediction intervals excluding the null value, and without hints of small-study effects (P for Egger's test > 0.10) or excess of significance (P > 0.05). Of the statistically significant (P < 0.05) genetic risk factors for PE, only PAI-1 4G/5G (recessive model) polymorphism was supported by strong evidence for a contribution to the pathogenesis of PE. Eleven factors (serum iron level, pregnancy-associated plasma protein-A, chronic kidney disease, polycystic ovary syndrome, mental stress, bacterial and viral infections, cigarette smoking, oocyte donation vs assisted reproductive technology, obesity vs normal weight, severe obesity vs normal weight and primiparity) presented highly suggestive evidence for an association with PE. CONCLUSIONS A large proportion of meta-analyses of genetic and non-genetic risk factors for PE have caveats that threaten their validity. Oocyte donation vs spontaneous conception and PAI-1 4G/5G polymorphism (recessive model) showed the strongest consistent evidence for an association with risk for PE. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- K Giannakou
- Cyprus International Institute for Environmental & Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - E Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - S I Papatheodorou
- Cyprus International Institute for Environmental & Public Health, Cyprus University of Technology, Limassol, Cyprus
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Unraveling the role of maternal anti-HLA class I antibodies in fetal and neonatal thrombocytopenia—Antibody specificity analysis using epitope data. J Reprod Immunol 2017; 122:1-9. [DOI: 10.1016/j.jri.2017.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/06/2017] [Accepted: 06/23/2017] [Indexed: 12/22/2022]
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Cerci Gurbuz B, Soyoz M, Ozkale Okyay D, Kilicaslan Ayna T, Pirim I. Comparison of Anti-HLA Antibody Production According to Gestational Periods in Pregnant Women. Transplant Proc 2017; 49:464-466. [PMID: 28340813 DOI: 10.1016/j.transproceed.2017.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND To evaluate paternal anti-HLA antibody profiles, sera samples were collected from pregnant women in different trimesters and the panel-reactive antibody (PRA) specificities were identified. METHODS From 2013 to 2015, serum samples were obtained from 41 pregnant women who had registered at the Izmir Tepecik Education and Research Hospital Gynecology Clinic. Anti-HLA antibodies were screened by using the panel reactive antibody screening and identification tests. Sera samples were obtained at the first, second, and third trimesters. The primary outcome was to determine the anti-HLA antibody production term during pregnancy; the secondary outcome was identification of anti-HLA antibodies. RESULTS None of the women had a sensitization history except during pregnancy. We observed that 54% of the women produced paternal antibodies, either class I or II. Class I PRA positivity of the women who had a first or second pregnancy was the same in all 3 trimesters, whereas class II positivity was increased in the third trimester. Class II and both class I and II positivity increased in the third trimester; class I positivity was decreased in the third trimester. PRA positivity could be affected by the history of pregnancy and could be raised, but no impact was observed from the history of abortion and miscarriage (odds ratios, 1.9, 0.4, and 0.5 [95% confidence intervals, 0.5-7.8, 0.1-2.0, and 0.3-0.7], respectively; P > .05). The most frequently detected antibodies were A2, B7, DR7, DR4, DR11, DR13, DQ2, and DQ8. CONCLUSIONS Anti-HLA antibodies against paternal HLA antigens were detected more in multiparous women than in primiparous women. Anti-HLA antibody detection ratios did not change until the third trimester and were followed by a specific increase in class II anti-HLA antibody production.
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Affiliation(s)
- B Cerci Gurbuz
- Izmir Katip Celebi University Faculty of Medicine, Department of Medical Biology and Genetics, Izmir, Turkey; University of Health Science Tepecik Training and Research Hospital, Tissue Typing Laboratory, Izmir, Turkey.
| | - M Soyoz
- Izmir Katip Celebi University Faculty of Medicine, Department of Medical Biology and Genetics, Izmir, Turkey; University of Health Science Tepecik Training and Research Hospital, Tissue Typing Laboratory, Izmir, Turkey
| | - D Ozkale Okyay
- University of Health Science Tepecik Training and Research Hospital, Clinic of Gynecology, Izmir, Turkey
| | - T Kilicaslan Ayna
- Izmir Katip Celebi University Faculty of Medicine, Department of Medical Biology and Genetics, Izmir, Turkey; University of Health Science Tepecik Training and Research Hospital, Tissue Typing Laboratory, Izmir, Turkey
| | - I Pirim
- Izmir Katip Celebi University Faculty of Medicine, Department of Medical Biology and Genetics, Izmir, Turkey; University of Health Science Tepecik Training and Research Hospital, Tissue Typing Laboratory, Izmir, Turkey
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Refsum E, Mörtberg A, Dahl J, Meinke S, Auvinen MK, Westgren M, Reilly M, Höglund P, Wikman A. Characterisation of maternal human leukocyte antigen class I antibodies in suspected foetal and neonatal alloimmune thrombocytopenia. Transfus Med 2016; 27:43-51. [DOI: 10.1111/tme.12375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/04/2016] [Accepted: 10/09/2016] [Indexed: 12/29/2022]
Affiliation(s)
- E. Refsum
- Department of Laboratory Medicine; Karolinska Institutet, Stockholm, Sweden
| | - A. Mörtberg
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
| | - J. Dahl
- Department of Medical Biology, Immunology Research Group; Arctic University of Norway; Tromso Norway
| | - S. Meinke
- Department of Medicine Huddinge, Center for Hematology and Regenerative Medicine (HERM); Karolinska Institutet; Stockholm Sweden
| | - M.-K. Auvinen
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
- Advanced Medical and Dental Institute; Universiti Sains Malaysia; George Town Malaysia
| | - M. Westgren
- Department of Obstetrics and Gynaecology; Karolinska University Hospital; Stockholm Sweden
| | - M. Reilly
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - P. Höglund
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
- Department of Medicine Huddinge, Center for Hematology and Regenerative Medicine (HERM); Karolinska Institutet; Stockholm Sweden
| | - A. Wikman
- Department of Laboratory Medicine; Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
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Letur H, Peigné M, Ohl J, Cédrin-Durnerin I, Mathieu-D'Argent E, Scheffler F, Grzegorczyk-Martin V, de Mouzon J. Hypertensive pathologies and egg donation pregnancies: Results of a large comparative cohort study. Fertil Steril 2016; 106:284-90. [PMID: 27025547 DOI: 10.1016/j.fertnstert.2016.03.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/04/2016] [Accepted: 03/16/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether egg donation (ED) pregnancies are at higher risk of pregnancy-induced hypertension (PIH) than those achieved by autologous assisted reproductive technology (ART; controls). DESIGN Anonymous comparative observational matched cohort study. SETTING Assisted reproductive technology centers. PATIENT(S) Two hundred seventeen ED and 363 control singleton pregnancies matched at 7-8 weeks (pregnancy date, parity, cycle type [fresh/frozen] and women's age). According to French practice, all women were under 45. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Percentage of PIH for ED versus controls. RESULT(S) The groups were comparable (mean age, 34.5). PIH was more frequent during ED pregnancies (17.8% vs. 5.3%), as was preeclampsia (11.2% vs. 2.8%) and eclampsia (1.8% vs. 0.0%). In multivariate analyses, PIH risk increased with ED (odds ratio [OR], 3.92; 95% confidence interval [CI], 1.93-7.97) and women's age (OR, 1.08; 95% CI, 1.00-1.16). No significant effect of previous pregnancies or cycle rank/type was observed. CONCLUSION(S) This study had sufficient power to detect doubling of the PIH rate. It was demonstrated that the risk of PIH was tripled for ED versus controls. Even in young women, ED is a risk factor for PIH. An immunological explanation seems most likely, that is, the fetus is fully allogeneic to its mother. This risk must be acknowledged to inform couples and provide careful pregnancy monitoring.
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Affiliation(s)
- Hélène Letur
- Centre de Fertilité, Institut Mutualiste Montsouris, Paris, France.
| | - Maëliss Peigné
- Service de Médecine de la Reproduction, Hôpital Jeanne de Flandre, Centre Hospitalier Régional et Universitaire, Lille, France
| | - Jeanine Ohl
- Service de Gynécologie-Obstétrique, Centre Médico-Chirurgical et Obstétrical, Centre Hospitalier Universitaire, Schiltigheim, France
| | - Isabelle Cédrin-Durnerin
- Service de Médecine de la Reproduction, Assistance Publique des Hôpitaux de Paris, Hôpital Jean-Verdier, Bondy, France
| | | | - Florence Scheffler
- Médecine et Biologie de la Reproduction, Cytogénétique et Centre d'Etude et de Conservation des Oeufs et du Sperme de Picardie, Centre Hospitalier Universitaire d'Amiens Sud, Amiens, France
| | - Veronika Grzegorczyk-Martin
- Service de Gynécologie-Obstétrique, Centre Hospitalier Intercommunal des 4 Villes, Site Sèvres, Sèvres, France
| | - Jacques de Mouzon
- Institut National de la Santé et de la Recherche Médicale, Service de Gynécologie-Obstétrique II et Médecine de la Reproduction, APHP, Cochin Port Royal, Paris, France
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Masoudian P, Nasr A, de Nanassy J, Fung-Kee-Fung K, Bainbridge SA, El Demellawy D. Oocyte donation pregnancies and the risk of preeclampsia or gestational hypertension: a systematic review and metaanalysis. Am J Obstet Gynecol 2016; 214:328-39. [PMID: 26627731 DOI: 10.1016/j.ajog.2015.11.020] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/17/2015] [Accepted: 11/20/2015] [Indexed: 12/25/2022]
Abstract
The purpose of this study was to determine whether pregnancies that were achieved via oocyte donation, compared with pregnancies achieved via other assisted reproductive technology methods or natural conception, demonstrate increased risk of preeclampsia or gestational hypertension. Comparative studies of pregnancies that were achieved with oocyte donation vs other methods of assisted reproductive technology or natural conception with preeclampsia or gestational hypertension were included as 1 of the measured outcomes. Abstracts and unpublished studies were excluded. Two reviewers independently selected studies, which were assessed for quality with the use of methodological index for non-randomized studies, and extracted the data. Statistical analysis was conducted. Of the 523 studies that were reviewed initially, 19 comparative studies met the predefined inclusion and exclusion criteria and were included in the metaanalysis, which allowed for analysis of a total of 86,515 pregnancies. Our pooled data demonstrated that the risk of preeclampsia is higher in oocyte-donation pregnancies compared with other methods of assisted reproductive technology (odds ratio, 2.54; 95% confidence interval, 1.98-3.24; P < .0001) or natural conception (odds ratio, 4.34; 95% confidence interval, 3.10-6.06; P < .0001). The risk of gestational hypertension was also increased significantly in oocyte donation pregnancies in comparison with other methods of assisted reproductive technology (odds ratio, 3.00; 95% confidence interval, 2.44-3.70; P < .0001) or natural conception (odds ratio, 7.94; 95% confidence interval, 1.73-36.36; P = .008). Subgroup analysis that was conducted for singleton and multiple gestations demonstrated a similar risk for preeclampsia and gestational hypertension in both singleton and multiple gestations. This metaanalysis provides further evidence that supports that egg donation increases the risk of preeclampsia and gestational hypertension compared with other assisted reproductive technology methods or natural conception.
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