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Nielsen JR, Kolte AM, Bliddal S, Jørgensen HL, Johnsen MG, Krog MC, Westergaard D, Nielsen HS. Evaluating risk factors in recurrent pregnancy loss: A prospective cohort study and its impact on live birth outcomes. J Reprod Immunol 2024; 165:104297. [PMID: 39029322 DOI: 10.1016/j.jri.2024.104297] [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: 02/29/2024] [Revised: 06/24/2024] [Accepted: 07/03/2024] [Indexed: 07/21/2024]
Abstract
Recurrent pregnancy loss (RPL) affects 1-2 % of all couples trying to conceive and is a challenging heterogeneous condition. This study aimed to evaluate the prevalence and impact of various risk factors in patients suffering from RPL. We performed a prospective cohort study including patients at the tertiary RPL Unit in the Capital Region of Denmark between 1st January 2000 and 1st January 2023. The main outcome of the study was the first pregnancy after referral and whether the pregnancy was ongoing at least to the 22nd gestational week. A total of 2555 patients were included in the study, out of whom 1892 patients achieved a pregnancy after referral to the RPL Unit. This resulted in 1103 live births (58.3 %) and 718 pregnancy losses (37.9 %). Maternal age, BMI, smoking status and the number of prior pregnancy losses were negatively correlated with the likelihood of achieving pregnancy. Furthermore, maternal age, prior pregnancy losses, antiphospholipid syndrome (APS) and uterine malformations were associated with reduced birth rates. Patients with secondary RPL had a higher birth rate compared to those with primary RPL, and patients with APS treated with low-molecular-weight heparin (LMWH) demonstrated a significantly increased birth rate compared to untreated APS patients. These findings suggest that certain risk factors significantly impact the likelihood of achieving pregnancy and live birth following RPL, which can be used in patient guidance.
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Affiliation(s)
- Josefine Reinhardt Nielsen
- The Recurrent Pregnancy Loss Unit, The Capital Region, Copenhagen University Hospitals, Hvidovre Hospital, DK-2650, Rigshospitalet, Copenhagen DK-2100, Denmark.
| | - Astrid Marie Kolte
- The Recurrent Pregnancy Loss Unit, The Capital Region, Copenhagen University Hospitals, Hvidovre Hospital, DK-2650, Rigshospitalet, Copenhagen DK-2100, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - Sofie Bliddal
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark; Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark; Department of Medical Endocrinology, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Henrik Løvendahl Jørgensen
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark; Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Morten Guldborg Johnsen
- The Recurrent Pregnancy Loss Unit, The Capital Region, Copenhagen University Hospitals, Hvidovre Hospital, DK-2650, Rigshospitalet, Copenhagen DK-2100, Denmark
| | - Maria Christine Krog
- The Recurrent Pregnancy Loss Unit, The Capital Region, Copenhagen University Hospitals, Hvidovre Hospital, DK-2650, Rigshospitalet, Copenhagen DK-2100, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark; Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9 ,Copenhagen 2100, Denmark
| | - David Westergaard
- The Recurrent Pregnancy Loss Unit, The Capital Region, Copenhagen University Hospitals, Hvidovre Hospital, DK-2650, Rigshospitalet, Copenhagen DK-2100, Denmark; Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Hvidovre DK-2650, Denmark
| | - Henriette Svarre Nielsen
- The Recurrent Pregnancy Loss Unit, The Capital Region, Copenhagen University Hospitals, Hvidovre Hospital, DK-2650, Rigshospitalet, Copenhagen DK-2100, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark; Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Hvidovre DK-2650, Denmark
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Perinatal Outcomes of Singleton Live Births Following Preimplantation Genetic Testing for Chromosomal Structural Rearrangements in Single Frozen-Thawed Blastocyst Transfer Cycles: a Retrospective Cohort Study. Reprod Sci 2021; 29:3039-3046. [PMID: 34716537 DOI: 10.1007/s43032-021-00732-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
This study investigated whether singleton pregnancies conceived after preimplantation genetic testing for chromosomal structural rearrangements (PGT-SR) are associated with a higher risk of adverse perinatal outcomes than singleton pregnancies conceived after intracytoplasmic sperm injection (ICSI). We collected data on singleton live births after PGT-SR (n = 107) and ICSI (n = 585) in our hospital from January 2017 to August 2020. Multivariable analyses were used to adjust for maternal age, body mass index, gravidity and parity, paternal age, ovulatory disorder, and recurrent spontaneous abortion. The unadjusted results showed a significantly higher risk of hypertensive disorders of pregnancy (HDP) (odds ratio (OR) = 2.47; 95% confidence interval (CI): 1.10-5.54; P = 0.029) associated with PGT-SR singleton pregnancies than with ICSI singleton pregnancies. However, after adjusting for potential confounders, there were no longer any significant differences in the risk of HDP (adjusted OR = 2.24; 95% CI: 0.92-5.48; P = 0.077) between PGT-SR and ICSI singleton pregnancies. There were no significant differences between PGT-SR and ICSI singleton pregnancies in terms of gestational diabetes, preterm premature rupture of membranes, placenta previa, cesarean delivery, gestational age (weeks), preterm delivery (< 37 weeks), very preterm delivery (≥ 28 weeks and < 32 weeks), birth weight (g), low birth weight (< 2500 g), very low birth weight (< 1500 g), birth height (cm), birth defects, and 1-min and 5-min Apgar scores. In conclusion, for single frozen-thawed blastocyst cycles, there were no significant differences in adverse perinatal outcomes between PGT-SR and ICSI singleton pregnancies. However, due to the limited sample size, these conclusions need to be confirmed by further studies.
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Oberg AS, VanderWeele TJ, Almqvist C, Hernandez-Diaz S. Pregnancy complications following fertility treatment-disentangling the role of multiple gestation. Int J Epidemiol 2019; 47:1333-1342. [PMID: 29939263 PMCID: PMC6124622 DOI: 10.1093/ije/dyy103] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/14/2018] [Indexed: 12/20/2022] Open
Abstract
Background To assess the extent to which multiple gestations mediate risk of pregnancy complications from fertility treatment and to address possible confounding by the underlying infertility. Methods From the nearly 1.8 million pregnancies recorded in the Swedish Medical Birth Register between 1996 and 2013, we selected the 9.9% (N = 174 067) that occurred to couples with known trouble conceiving (clinical infertility). Fertility treatment was identified from self-reports, medical records and procedural information from fertility clinics. We used logistic regression to estimate odds ratios (ORs) and their 95% confidence intervals (CIs), and decomposed the total effect into direct and mediated effects to estimate the proportion mediated by multiple gestations. Results Compared with pregnancies achieved without any assistance, those having received some treatment had higher odds of all studied complications except gestational diabetes. Associations with placenta previa (OR 2.17, 95% CI 1.95-2.40) and placental abruption (OR 1.77, 95% CI 1.54-2.03) were almost entirely independent of multiple gestations. In contrast, the majority of the associations with preterm birth (OR 1.69, 95% CI 1.62-1.77), caesarean delivery (RR 1.15, 95% CI 1.13-1.17) and pre-eclampsia (OR 1.17, 95% CI 1.11-1.22) were mediated by multiple gestations (87%, 62% and 91% of the effect mediated, respectively). Both direct and mediated pathways contributed to the remaining positive associations with chorioamnionitis, labour induction and postpartum haemorrhage. Results were similar when considering primi- and multi-parous women separately, and after restriction to assisted reproductive technologies only. Conclusion Multiple gestations are responsible for a large proportion of pregnancy complications associated with fertility treatment, suggesting that interventions to restrict the occurrence of multiples could reduce excess risk of pre-eclampsia, preterm birth and caesarean delivery after fertility treatment. However, the elevated risk of serious placental complications after fertility treatment appears to be largely independent of multiple gestations.
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Affiliation(s)
- Anna Sara Oberg
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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Hudic I, Stray-Pedersen B, Skokic F, Fatusic Z, Zildzic-Moralic A, Skokic M, Fatusic J. LOW PRETERM BIRTH RATE WITH DECREASING EARLY NEONATAL MORTALITY IN BOSNIA AND HERZEGOVINA DURING 2007-2014. Mater Sociomed 2016; 28:32-5. [PMID: 27047264 PMCID: PMC4789633 DOI: 10.5455/msm.2016.28.32-35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 11/15/2015] [Indexed: 11/03/2022] Open
Abstract
THE AIM of the study was to determine the situation of preterm births and early neonatal mortality during 2007-2014 in Tuzla Canton, Bosnia and Herzegovina. METHODS The study covers a 8-year period and is based on the protocols at the Tuzla Clinic for Gynecology and Obstetrics that covers all birth in Tuzla Canton area. We analyzed the gestational age of all newborns and recorded the number of neonatal deaths in the first week after birth. Demographics, pregnancy and birth characteristics were collected from the maternal records. RESULTS The total number of births in the period was 32738. Preterm birth was identified in 2401 (7.3%) cases with 12,5% occurring before 32 gestational weeks and 64% in 35-36 gestational weeks. The mothers of the 24-31 gws preterm group were significantly younger that those in the 32-36 group. In the 32-36 group there were significantly greater proportions of mothers with assisted reproductive technology and pre-eclampsia and 16.7% was medical induced preterm births versus 11.4 % in the 24-31 PTB group, p<0.05. The incidence of PTB did no vary significantly during the period, the lowest rate was found in 2010 (6.4%). A total of 221 children died giving a early mortality rate of 6.8 per 1000 live born over the 8 years. The majority 156 dying infants (70.6%) were preterm, only 5.7% died being born in the 35-36 gestational week (5.9 per 1000). Overall the preterm early mortality (7.3 per 1000) has shown a decreasing tendency during the latter years. CONCLUSION During the last 8 years there have been no significant decline in preterm birth in the Tuzla region while a decline in early neonatal death has been registered.
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Affiliation(s)
- Igor Hudic
- Clinic for Gynecology and Obstetrics, University Clinical Center, Tuzla, Bosnia and Herzegovina
| | - Babill Stray-Pedersen
- Division of Women and Children, Rikshospitalet, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Fahrija Skokic
- Children's Hospital, University Clinical Center Tuzla, Bosnia and Herzegovina
| | - Zlatan Fatusic
- Clinic for Gynecology and Obstetrics, University Clinical Center, Tuzla, Bosnia and Herzegovina
| | | | - Maida Skokic
- Children's Hospital, University Clinical Center Tuzla, Bosnia and Herzegovina
| | - Jasenko Fatusic
- Clinic for Gynecology and Obstetrics, University Clinical Center, Tuzla, Bosnia and Herzegovina
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Stanford JB, Simonsen SE, Baksh L. Fertility treatments and adverse perinatal outcomes in a population-based sampling of births in Florida, Maryland, and Utah: a cross-sectional study. BJOG 2015; 123:718-29. [PMID: 26148540 DOI: 10.1111/1471-0528.13510] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate perinatal outcomes associated with fertility treatments, including assisted reproductive technology (ART), intrauterine insemination with ovulation stimulation (IUI), and ovulation stimulation alone (OS). DESIGN Population-representative cross-sectional survey of women with live births, 2004-2008. SETTING Florida, Maryland, and Utah, USA. SAMPLE 21 803 women, weighted to represent 1 022 597 women. METHODS Survey and birth certificate data were analysed with logistic regression models adjusted for age, education, race, income, and parity, using separate models for singletons and all births. We used two referent groups: (1) women who never used fertility treatment and (2) subfertile women conceiving without treatment. MAIN OUTCOME MEASURES Preterm birth (<37 weeks), very preterm birth (<34 weeks), low birthweight (<2500 g), and very low birthweight (<1500 g). RESULTS Referent group 1: In singletons, ART was associated with preterm birth (OR 3.28; 95% CI 1.74, 6.20) and low birthweight (OR 2.91; 95% CI 1.99, 4.26). OS was also associated with low birthweight (OR 1.62; 95% CI 1.19, 2.19). Including all births, treatment was associated with preterm birth and low birthweight: ART (OR 6.21; 95% CI 4.21, 9.16 and OR 6.51; 95% CI 4.85, 8.73); IUI (OR 2.10; 95% CI 1.24, 3.56 and OR 2.41; 95% CI 1.54, 3.76); OS (OR 1.40; 95% CI 1.01, 1.94 and OR 2.10; 95% CI 1.60, 2.75), respectively. Referent group 2: ART was associated with both outcomes in all births, but not singletons. CONCLUSIONS Preterm birth and low birthweight associated with fertility treatments are largely attributable to multiple gestation, but are also related to underlying subfertility. TWEETABLE ABSTRACT Preterm birth is associated with subfertility, and with fertility treatments through multiple gestation.
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Affiliation(s)
- J B Stanford
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - S E Simonsen
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - L Baksh
- Utah Department of Health, Maternal and Infant Health Program, Salt Lake City, UT, USA
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Messerlian C, Platt RW, Ata B, Tan SL, Basso O. Do the causes of infertility play a direct role in the aetiology of preterm birth? Paediatr Perinat Epidemiol 2015; 29:101-12. [PMID: 25644431 DOI: 10.1111/ppe.12174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is well established that singletons born of assisted reproductive technology are at higher risk of preterm birth and other adverse outcomes. What remains unclear is whether the increased risk is attributable to the effects of the treatment alone or whether the underlying causes of infertility also play a role. The aim of this study was to examine whether any of the six categories of causes of infertility were associated with a direct effect on preterm birth using causal mediation analysis. METHODS We assembled a hospital-based cohort of births delivered at a large tertiary care hospital in Montreal, Canada between 2001 and 2007. Causes of infertility were ascertained through a clinical database and medical chart abstraction. We employed marginal structural models (MSM) to estimate the controlled direct effect of each cause of infertility on preterm birth compared with couples without the cause under examination. RESULTS The final study cohort comprised 18,598 singleton and twin pregnancies, including 1689 in couples with ascertained infertility. MSM results suggested no significant direct effect for any of the six categories of causes. However, power was limited in smaller subgroup analyses, and a possible direct effect for uterine abnormalities (e.g. fibroids and malformations) could not be ruled out. CONCLUSION In this cohort, most of the increased risk of preterm birth appeared to be explained by maternal characteristics (such as age, body mass index, and education) and by assisted reproduction. If these findings are corroborated, physicians should consider these risks when counselling patients.
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Affiliation(s)
- Carmen Messerlian
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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Wise LA. Infertility and preterm delivery: what do we know and where do we go from here? Paediatr Perinat Epidemiol 2015; 29:97-100. [PMID: 25711128 DOI: 10.1111/ppe.12180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA; Slone Epidemiology Center, Boston University, Boston, MA
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Wise LA, Mikkelsen EM, Sørensen HT, Rothman KJ, Hahn KA, Riis AH, Hatch EE. Prospective study of time to pregnancy and adverse birth outcomes. Fertil Steril 2015; 103:1065-1073.e2. [PMID: 25707334 DOI: 10.1016/j.fertnstert.2015.01.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the association between time to pregnancy (TTP) and adverse birth outcomes. DESIGN Prospective cohort study. SETTING Not applicable. PATIENT(S) A total of 3,521 singletons born to women aged 18-40 years at cohort entry. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Selected birth outcomes, including preterm birth (PTB, <37 weeks' gestation), low birth weight (<2,500 g), small for gestational age, large for gestational age, and placental disorders, ascertained from the Danish Medical Birth Registry and Danish National Registry of Patients. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using log-binomial regression, with adjustment for potential confounders and fertility treatment. RESULT(S) Multivariable RRs for PTB in relation to TTP of 3-5, 6-11, and ≥12 vs. <3 cycles were 1.59 (95% CI 0.94-2.69), 0.85 (95% CI 0.48-1.50), and 1.57 (95% CI 0.93-2.65). The association was slightly stronger for spontaneous PTB (TTP ≥12 vs. <3 cycles: RR 1.69, 95% CI 0.84-3.42) than for medically indicated PTB (RR 1.39, 95% CI 0.62-3.12). Longer TTPs (≥12 cycles) were associated with increased risks of low birth weight (RR 1.80, 95% CI 0.97-3.35), cesarean delivery (RR 1.64, 95% CI 1.27-2.12), placental disorders (RR 2.21, 95% CI 1.07-4.56), ischemic placental disease (RR 1.56, 95% CI 0.99-2.44), pre-eclampsia (RR 1.45, 95% CI 0.79-2.65), and postpartum hemorrhage (RR 1.58, CI 1.14-2.19), and decreased risks of macrosomia (≥4,500 g; RR 0.63, 95% CI 0.35-1.13) and large for gestational age (RR 0.76, 95% CI 0.58-1.00). Longer TTP showed little association with small for gestational age. CONCLUSION(S) In a prospective cohort study of Danish pregnancy planners, delayed conception was a marker for adverse birth outcomes, after accounting for fertility treatment.
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Affiliation(s)
- Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts; Slone Epidemiology Center, Boston University, Boston, Massachusetts.
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts; RTI Health Solutions, Research Triangle Institute, Research Triangle Park, North Carolina
| | - Kristen A Hahn
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Anders H Riis
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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Birth defects and congenital health risks in children conceived through assisted reproduction technology (ART): a meeting report. J Assist Reprod Genet 2014; 31:947-58. [PMID: 24870703 DOI: 10.1007/s10815-014-0255-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/08/2014] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Assisted Reproduction Treatment (ART) is here to stay. This review addresses the parental background of birth defects, before, during and after conception and focuses both on the underlying subfertility and on the question whether ART as a treatment is an additional contributing factor. METHODS Searches were performed in Medline and other databases. Summaries were discussed in a Delphi panel set-up by the European Society of Human Reproduction and Embryology (ESHRE). RESULTS Several birth defects and adult diseases arise during the earliest stages of ovarian development and oocyte differentiation: this is the case of cleft palate disorders in offspring from female rat exposed to Dioxin during fetal life or the polycystic ovary diseases in female offspring (primates) exposed to elevated androgen concentration during fetal life. Human oocytes and embryos often fail to stop the propagation of aneuploid cells but maintain their ability to repair DNA damages including those introduced by the fertilizing sperm. There is a 29 % increased risk of birth defects in the newborns spontaneously conceived by subfertile couples and the risk is further increased (34 %) when conception is achieved by treating infertlity with ART (Danish IVF Registry). Periconceptional conditions are critical for ART babies: their birth weight is in general smaller (Norvegian Registry) but a more prolonged culture time doubled the number of large babies (Finnish Registry). CONCLUSION The long-term developmental effects of ART on child and subsequent health as an adult remains a subject worthy of futher monitoring and investigation.
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Blood pressure and anthropometrics of 4-y-old children born after preimplantation genetic screening: follow-up of a unique, moderately sized, randomized controlled trial. Pediatr Res 2013; 74:606-14. [PMID: 23949731 DOI: 10.1038/pr.2013.137] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 04/02/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recent studies suggest that in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are associated with suboptimal cardiometabolic outcome in offspring. It is unknown whether preimplantation genetic screening (PGS), which involves embryo biopsy, affects blood pressure (BP), anthropometrics, and the frequency of received medical care. METHODS In this prospective multicenter follow-up study, we assessed BP, anthropometrics, and received medical care of 4-y-old children born to women who were randomly assigned to IVF/ICSI with PGS (n = 49) or without PGS (controls; n = 64). We applied linear and generalized linear mixed-effects models to investigate possible effects of PGS. RESULTS BP in the PGS and control groups was similar: 102/64 and 100/64 mm Hg, respectively. Main anthropometric outcomes in the PGS vs. control group were: BMI: 16.1 vs. 15.8; triceps skinfold: 108 vs. 98 mm; and subscapular skinfold: 54 vs. 53 mm (all P values > 0.05). More PGS children than controls had received paramedical care (speech, physical, or occupational therapy: 14 (29%) vs. 9 (14%); P = 0.03 in multivariable analysis). The frequency of medicial treatment was comparable. CONCLUSION PGS does not seem to affect BP or anthropometrics in 4-y-old children. The higher frequency of received paramedical care after PGS may suggest an effect of PGS on subtle developmental parameters.
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Anbazhagan A, Hunter A, Breathnach FM, Mcauliffe FM, Geary MP, Daly S, Higgins JR, Morrison JJ, Burke G, Higgins S, Dicker P, Tully E, Carroll S, Malone FD. Comparison of outcomes of twins conceived spontaneously and by artificial reproductive therapy. J Matern Fetal Neonatal Med 2013; 27:458-62. [DOI: 10.3109/14767058.2013.818653] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hammond G, Langridge A, Leonard H, Hagan R, Jacoby P, DeKlerk N, Pennell C, Stanley F. Changes in risk factors for preterm birth in Western Australia 1984-2006. BJOG 2013; 120:1051-60. [PMID: 23639083 DOI: 10.1111/1471-0528.12188] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To characterise changing risk factors of preterm birth in Western Australia between 1984 and 2006. DESIGN Population-based study. SETTING Western Australia. POPULATION All non-Aboriginal women giving birth to live singleton infants between 1984 and 2006. METHODS Multinomial, multivariable regression models were used to assess antecedent profiles by preterm status and labour onset types (spontaneous, medically indicated, prelabour rupture of membranes [PROM]). Population attributable fraction (PAF) estimates characterized the contribution of individual antecedents as well as the overall contribution of two antecedent groups: pre-existing medical conditions (including previous obstetric history) and pregnancy complications. MAIN OUTCOME MEASURE Antecedent relationships with preterm birth, stratified by labour onset type. RESULTS Marked increases in maternal age and primiparous births were observed. A four-fold increase in the rates of pre-existing medical complications over time was observed. Rates of pregnancy complications remained stable. Multinomial regression showed differences in antecedent profiles across labour onset types. PAF estimates indicated that 50% of medically indicated preterm deliveries could be eliminated after removing six antecedents from the population; estimates for PROM and spontaneous preterm reduction were between 10 and 20%. Variables pertaining to previous and current obstetric complications (previous preterm birth, previous caesarean section, pre-eclampsia and antepartum haemorrhage) were the most influential predictors of preterm birth and adverse labour onset (PROM and medically indicated). CONCLUSIONS Preterm antecedent profiles have changed markedly over the 23 years studied. Some changes may be attributable to true change, others to advances in surveillance and detection. Still others may signify change in clinical practice.
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Affiliation(s)
- G Hammond
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia.
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Kondapalli LA, Perales-Puchalt A. Low birth weight: is it related to assisted reproductive technology or underlying infertility? Fertil Steril 2013; 99:303-10. [PMID: 23375144 DOI: 10.1016/j.fertnstert.2012.12.035] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 12/21/2012] [Accepted: 12/21/2012] [Indexed: 02/03/2023]
Abstract
Since 1978, we have witnessed a successful evolution of assisted reproductive technology (ART), with improvement of the pregnancy rates and a growing demand. However, in recent years, there has been increasing concern regarding its safety due to the potential health impact on its infants. The raise of the developmental origins of adult disease has positioned low birth weight (LBW) as a significant health issue. Although multiple studies have associated ART with LBW, the etiology of this association remains largely unknown. We review the potential association between different components of ART and infertility with LBW, while acknowledging the limitations of interpretation of the existing literature.
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Affiliation(s)
- Laxmi A Kondapalli
- Section of Reproductive Endocrinology and Infertility, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA.
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Schendelaar P, Middelburg KJ, Bos AF, Heineman MJ, Kok JH, La Bastide-Van Gemert S, Seggers J, Van den Heuvel ER, Hadders-Algra M. The effect of preimplantation genetic screening on neurological, cognitive and behavioural development in 4-year-old children: follow-up of a RCT. Hum Reprod 2013; 28:1508-18. [PMID: 23535872 DOI: 10.1093/humrep/det073] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Does embryo biopsy inherent to preimplantation genetic screening (PGS) affect neurological, cognitive and behavioural development of 4-year-old children? SUMMARY ANSWER PGS does not seem to affect neurological, cognitive and behavioural development of 4-year-old singletons; however, our data suggest that it may be associated with altered neurodevelopment in twins. WHAT IS KNOWN ALREADY Evidence concerning the safety of PGS on neurodevelopmental outcome in offspring is scarce. The present study provides information on neurodevelopmental, cognitive and behavioural outcome of 4-year-old PGS offspring. STUDY DESIGN, SIZE, DURATION A prospective, assessor-blinded follow-up study of children born to women who participated in a multi-centre RCT on the effect of IVF with or without PGS. PARTICIPANTS/MATERIALS, SETTING, METHODS At 4 years, 49 children (31 singletons, 9 sets of twins) born following IVF with PGS and 64 children (42 singletons, 11 sets of twins) born following IVF without PGS (controls) were assessed (post-natal attrition 18%). Neurological development was evaluated with the standardized, age-specific and sensitive neurological examination according to Hempel, resulting in a neurological optimality score (NOS), a fluency score and the rate of adverse neurological outcome. Primary outcome was the fluency score, as fluency of movements is easily reduced by subtle dysfunction of the brain. Cognitive development was evaluated with the Kaufman Assessment Battery for Children; behavioural development was evaluated with the Child Behavior Checklist. The effect of PGS was analysed with a mixed effects model. MAIN RESULTS AND THE ROLE OF CHANCE Based on the intention to treat analysis, neurodevelopmental outcome of PGS children was similar to that of controls. However, additional analyses indicated that PGS affected neurodevelopmental outcome of twins in a different way than that of singletons. The fluency score of singletons born following PGS was similar to that of control singletons [mean values, 95% confidence intervals (CIs): 12.2 (11.5;12.8) and 12.2 (11.6;12.8)], respectively, P = 0.977) that was also true for the other neurodevelopmental parameters. The fluency score of PGS twins was significantly lower than that of control twins [mean values, 95% CIs: 10.6 (9.8;11.3) and 12.3 (11.5;13.1)], respectively, P = 0.001); the same was true for the NOS. In addition, PGS in twins was associated with a higher sequential intelligence quotient score. On the other hand, other neurodevelopmental parameters were similar for PGS twins and control twins. Post hoc sample size calculation for the primary outcome parameter, the fluency score, indicated that the study groups, including the subgroups of singletons and twins, were adequately powered. LIMITATIONS, REASONS FOR CAUTION We assessed singletons and twins who contributed to the generalizability of the study. A limitation of our study is the relative small size of our study groups and the selective dropout in both groups (dropouts PGS group: higher gestational age; control group: less well-educated parents). These preclude the conclusion that PGS per se is not associated with neurodevelopmental, cognitive and behavioural problems in singletons and the conclusion that PGS is associated with altered neurodevelopmental outcome in twins. WIDER IMPLICATIONS OF THE FINDINGS The need for careful long-term monitoring of children born following embryo biopsy remains, as it is still applied in the form of PGD and it is still unknown whether embryo biopsy affects long-term neurodevelopmental outcome.
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Affiliation(s)
- P Schendelaar
- Department of Paediatrics, Division of Developmental Neurology-CA 85, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Messerlian C, Maclagan L, Basso O. Infertility and the risk of adverse pregnancy outcomes: a systematic review and meta-analysis. Hum Reprod 2012; 28:125-37. [DOI: 10.1093/humrep/des347] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dysmorphic features in 2-year-old IVF/ICSI offspring. Early Hum Dev 2012; 88:823-9. [PMID: 22795820 DOI: 10.1016/j.earlhumdev.2012.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 06/04/2012] [Accepted: 06/09/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND An increased risk of major congenital abnormalities after IVF and ICSI has been described, but underlying mechanisms are unclear. This study evaluates the effects of ovarian hyperstimulation, the in vitro procedure and time to pregnancy (TTP) - as proxy for the severity of subfertility - on the prevalence of dysmorphic features. DESIGN/METHODS Participants were singletons born following controlled ovarian hyperstimulation-IVF/ICSI (COH-IVF/ICSI; n=66), or modified natural cycle-IVF/ICSI (MNC-IVF/ICSI; n=56), or to subfertile couples who conceived naturally (Sub-NC; n=86). Dysmorphic features were assessed according to the method of Merks et al., and are classified into 'minor variants' (minor anomalies or common variants) and 'abnormalities' (clinically relevant or irrelevant abnormalities). We focussed on minor anomalies as they indicate altered embryonic development and because they have the advantage of a higher prevalence. RESULTS The prevalences of any of the outcome measures were similar in the three groups. One or more minor anomalies, our primary outcome measure, occurred in 50% of COH-IVF/ICSI, 54% of MNC-IVF/ICSI and 53% of Sub-NC children. TTP in years was significantly associated with abnormalities (adjustedOR=1.20; 95%CI=1.02-1.40), especially with clinically relevant abnormalities (adjustedOR=1.22; 95%CI=1.01-1.48). CONCLUSIONS The study indicates that ovarian hyperstimulation and the in vitro procedure are not associated with an increase in dysmorphic features. The positive association between TTP and clinically relevant abnormalities suggests a role of the underlying subfertility and its determinants in the genesis of dysmorphic features.
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Henderson JJ, McWilliam OA, Newnham JP, Pennell CE. Preterm birth aetiology 2004-2008. Maternal factors associated with three phenotypes: spontaneous preterm labour, preterm pre-labour rupture of membranes and medically indicated preterm birth. J Matern Fetal Neonatal Med 2011; 25:642-7. [PMID: 21827362 DOI: 10.3109/14767058.2011.597899] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To (1) investigate the current distribution of PTB phenotypes; (2) identify factors associated with spontaneous preterm labour (SPTL), PPROM, and indicated PTB; (3) investigate the relationship of gestational age (ga) with each PTB phenotype. METHODS Retrospective review of all live, singleton births 23(+0) to 36(+6) weeks ga at an obstetric referral centre 2004-2008. RESULTS A total of 4,522 PTBs were included (SPTL 31.7%, PPROM 27.4%, indicated 40.8%). PTB phenotype distribution differed between ga groups (<27 weeks: SPTL 45%, PPROM 32%, indicated 23%; 27-33 weeks: SPTL 30%, PPROM 32%, indicated 39%; 34-36 weeks: SPTL 32%, PPROM 24%, indicated 44%, p < 0.001). Between 34-36 weeks', demographic factors were significantly different between PTB phenotypes (age ≥35: SPTL 13.8%, PPROM 15.4%, indicated 21.6%; Caucasian ethnicity: SPTL 61.6%, PPROM 69.0%, indicated 70.2%; Assisted Reproductive Technology (ART): SPTL 2.8%, PPROM 1.9%, indicated 9.3%; all p < 0.001). Between 27-33 weeks' PTB phenotype was associated with smoking (SPTL 24.9%, PPROM 29.3%, indicated 20.2%; p = 0.002) and ART (SPTL 2.3%, PPROM 1.6%, indicated 5.0%; p = 0.002). Demographic factors were not associated with PTB phenotype at 23-26 weeks. CONCLUSIONS The increase in PTB rates may be explained by medical indications at late preterm gestations, primarily in older, Caucasian women requiring fertility assistance. Interventions to reduce the rate of PTB need to be targeted to this high-risk population.
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Affiliation(s)
- Jennifer J Henderson
- School of Women's and Infants' Health, The University of Western Australia, Perth, Australia.
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Rimm AA, Katayama AC, Katayama KP. A meta-analysis of the impact of IVF and ICSI on major malformations after adjusting for the effect of subfertility. J Assist Reprod Genet 2011; 28:699-705. [PMID: 21625967 DOI: 10.1007/s10815-011-9583-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 05/13/2011] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To estimate the effect of assisted reproductive technology (ART) on major malformation (MM) rate in ART offspring independent of the effect of subfertility on MM. DESIGN Meta-analysis. METHODS This meta-analysis is based on our previously published meta-analysis of observational studies evaluating the relationship between ART treatment and MM rates, as well as recent research by Zhu et al. to estimate the impact of subfertility alone on MM in subfertile couples conceiving spontaneously. RESULTS The overall odds ratio for MM in our original meta-analysis, in which all studies used apparently inappropriate control groups of "normal" populations, was 1.29 (95% CI 1.01-1.67). Here we attempted to estimate the risk of subfertility and used this estimate to perform an adjusted meta-analysis. Zhu et al. found that about 40% of the odds of MM was due to subfertility. When we took Zhu's finding into account, the adjusted odds ratio in the meta-analysis was 1.01 (95% CI 0.82-1.23). CONCLUSIONS Our study suggests ART does not increase the risk of MM as much as previously reported. More research is needed to quantify the underlying risk of subfertility and separate it from the risk associated with ART. Physicians who counsel subfertile couples should recognize that previous studies of MM rates in ART patients probably overestimated the risk.
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Affiliation(s)
- Alfred A Rimm
- Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, OH 44106-4945, USA.
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Wisborg K, Ingerslev HJ, Henriksen TB. In vitro fertilization and preterm delivery, low birth weight, and admission to the neonatal intensive care unit: a prospective follow-up study. Fertil Steril 2010; 94:2102-6. [PMID: 20188361 DOI: 10.1016/j.fertnstert.2010.01.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 01/05/2010] [Accepted: 01/08/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the risk of preterm delivery, low birth weight, and admission of the newborn to a neonatal intensive care unit (NICU) in women pregnant after fertility treatment and subfertile women with the risk in fertile women. DESIGN Prospective follow-up study. SETTING Aarhus University Hospital, Skejby, Denmark, 1989-2006. PATIENT(S) A total of 20,080 liveborn singletons. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Preterm delivery, low birth weight, and admission of the newborn to a NICU. RESULT(S) After adjustment we found a statistically significantly increased risk of preterm delivery and very preterm delivery in women who conceived after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) compared with fertile women. Compared with fertile women, the risk of preterm delivery and very preterm delivery was not statistically significantly different in women pregnant after non-IVF assisted reproductive treatment (non-IVF ART) or subfertile women. We found no association between IVF/ICSI and the risk of low birth weight at term or admittance to the NICU. CONCLUSION(S) The increased risk of preterm delivery after IVF/ICSI may be due to the fertility treatment or unknown characteristics in the couples who undergo IVF/ICSI.
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Affiliation(s)
- Kirsten Wisborg
- Perinatal Epidemiology Research Unit, Department of Paediatrics, Aarhus University Hospital, Skejby, Aarhus, Denmark.
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Boulet SL, Schieve LA, Nannini A, Ferre C, Devine O, Cohen B, Zhang Z, Wright V, Macaluso M. Perinatal outcomes of twin births conceived using assisted reproduction technology: a population-based study. Hum Reprod 2008; 23:1941-8. [DOI: 10.1093/humrep/den169] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Schieve LA, Cohen B, Nannini A, Ferre C, Reynolds MA, Zhang Z, Jeng G, Macaluso M, Wright VC. A Population-Based Study of Maternal and Perinatal Outcomes Associated with Assisted Reproductive Technology in Massachusetts. Matern Child Health J 2007; 11:517-25. [PMID: 17345154 DOI: 10.1007/s10995-007-0202-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 02/12/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess associations between assisted reproductive technology (ART) and adverse maternal and infant outcomes, with an emphasis on singletons. METHODS We linked data from the US ART surveillance system with Massachusetts live birth-infant death records data for resident births in 1997-1998 and compared births conceived with ART (N = 3316) with births not conceived with ART or infertility medications (N = 157,066) on: maternal chronic conditions, pregnancy complications, labor and delivery complications, and perinatal and infant outcomes. RESULTS Overall, ART was strongly associated with numerous adverse outcomes. The magnitude was reduced for several outcomes when analyses were limited to singletons. After further exclusion of maternal subsets with rare ART births (maternal age <20; education <high school; unmarried, no or public health insurance; no or third trimester prenatal care initiation), and matching ART and non-ART singletons on birth hospital, birth month and year, maternal age, parity, and race/ethnicity, ART remained associated with pre-existing diabetes (Relative Risk [RR] = 2.2 95% confidence interval 1.02-4.9), incompetent cervix (RR = 6.0, [2.3-15.4]), pregnancy-induced hypertension (RR = 1.5, [1.04-2.2]), uterine bleeding (RR = 3.2, [1.5-6.8]), placental abruption (RR = 3.8 [1.6-9.4]), placenta previa (RR = 3.8, [1.6-9.4]), preterm delivery (RR = 2.4, [1.8-3.0]), very preterm delivery (RR = 2.5, [1.2-5.2]), low birth weight (RR = 2.1, [1.5-2.9]), and infant not discharged home (RR = 1.8, [1.2-2.6]). CONCLUSIONS Women who conceive with ART are more likely than women who do not to enter pregnancy with a chronic condition and develop complications during pregnancy and labor and delivery. Additionally, infants born after ART are at increased risk for adverse health outcomes. The mechanisms underlying these associations require further study.
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Affiliation(s)
- Laura A Schieve
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Schimmel MS, Hammerman C, Lusky A, Reichman B. Very low-birth-weight-infants conceived by in vitro fertilization are not at higher risk for mortality and morbidity: a population-based study. Fertil Steril 2006; 85:907-12. [PMID: 16580373 DOI: 10.1016/j.fertnstert.2005.09.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Revised: 09/28/2005] [Accepted: 09/28/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether excess mortality, neonatal morbidity, and congenital malformations occurred in in vitro fertilization (IVF) conceived compared with naturally conceived singleton, twin and triplet very low birth weight (VLBW) infants. DESIGN Population-based observational study from 1995 through 2002. SETTING Israel National VLBW infant database. PATIENT(S) A total of 8,181 VLBW infants conceived naturally or by IVF were stratified into groups of singletons and complete sets of twins and triplets. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Neonatal mortality and morbidity. RESULT(S) In the unadjusted analyses, mortality and neonatal morbidity rates were generally similar between the IVF-conceived and the naturally conceived infants stratified by plurality groups. When adjusted for multiple confounding variables, no excess neonatal mortality or morbidity occurred among IVF-conceived infants. The risk for congenital malformations adjusted for ethnicity, maternal age, and parity was also not increased in the IVF-conceived groups. CONCLUSION(S) In our population, VLBW infants conceived by IVF were not at increased risk for congenital malformations, postnatal morbidity, or mortality when compared with naturally conceived infants.
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Affiliation(s)
- Michael S Schimmel
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.
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Borgiani P, Nicotra M, Amante A, Lucarini N, Cosmi E, Bottini E. Intrauterine development and MNSs blood groups in repeated spontaneous abortion. Int J Gynaecol Obstet 2003; 81:207-11. [PMID: 12706279 DOI: 10.1016/s0020-7292(03)00046-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To determine whether the maternal MNSs genotype has an effect on the birth weight and gestation duration of the live offspring of women with repeated primary spontaneous abortion (RSA). METHODS The study sample consisted of 239 healthy white women who had been delivered of a live infant, and 137 women with a history of primary RSA-54 of whom had recently been delivered of a live infant and 83 who had had a spontaneous abortion. Maternal MNSs phenotypes were determined by standard serological methods, and the results were analyzed for relationships between these phenotypes and the mothers' reproductive status and the infants' birth weight and gestational age. Analysis of variance, the chi(2)-test of independence, and the Mantel-Haenszel test for linear association were performed for data analysis. RESULTS Infants born to mothers with the Ss genotype showed significantly lower birth weight and gestational duration compared with the infants of mothers with other genotypes. Additionally, the MNSs haplotype was found to be associated with birth weight. CONCLUSIONS Previous studies have shown that the MNSs system influences the gestational age of aborted fetuses in cases of RSA. The present study supports the hypothesis that this genetic factor influences intrauterine growth and development in women experiencing RSA.
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Affiliation(s)
- P Borgiani
- Department of Biopathology, School of Medicine, University of Rome Tor Vergata, Rome, Italy
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Lambalk CB, van Hooff M. Natural versus induced twinning and pregnancy outcome: a Dutch nationwide survey of primiparous dizygotic twin deliveries. Fertil Steril 2001; 75:731-6. [PMID: 11287027 DOI: 10.1016/s0015-0282(01)01679-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare obstetrical outcome of twin pregnancies after assisted reproduction with that of natural twin pregnancies. DESIGN Retrospective national database study. SETTING Academic Medical Centre. PATIENT(S) One thousand ninety-three primiparous mothers registered in the Dutch National Birth Registry who gave birth to a dizygotic (DZ) twin (male/female) in 1994, 1995, and 1996. We compared 613 natural twin pregnancies and 480 twin pregnancies born after assisted reproduction. MAIN OUTCOME MEASURE(S) Gestational length, mode of delivery, mode of presentation of the children, birth weight, APGAR score, congenital anomalies, perinatal mortality rate, highest recorded maternal diastolic blood pressure, and maternal postpartum complications. RESULT(S) Rates of perinatal mortality and very premature parturition (<29 weeks) were lower in natural twin mothers. Overall, induced DZ twins were born 3.5 days earlier with a lower birth weight and APGAR score compared with controls. Rates of congenital anomalies and incidence of cesarean section were not different. The highest recorded diastolic blood pressure was lower in induced twinning with a 30% lower incidence of diastolic blood pressure >90 mm Hg. CONCLUSION(S) Obstetric outcome for induced DZ twin pregnancy is less optimal than in natural DZ twin pregnancy. Twinning in assisted reproduction is known for its contribution to the high rate of premature deliveries, but in addition being a subfertile patient undergoing treatment makes an intrinsic contribution to adverse events as well.
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Affiliation(s)
- C B Lambalk
- Research Institute of Endocrinology, Reproduction and Metabolism, Department of Obstetrics and Gynaecology, Medical Centre Vrije Universiteit, Amsterdam, The Netherlands.
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Corrêa MV. [New reproductive technologies: oocyte donation. What could be new in this field?]. CAD SAUDE PUBLICA 2000; 16:863-70. [PMID: 11035527 DOI: 10.1590/s0102-311x2000000300036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This article discusses the so-called "new" reproductive technologies. The author analyzes and challenges this adjective, since for over two decades this group of medical techniques and experiments has been widely disseminated in the medical market. The media's coverage of test tube babies, and especially developments in intervention on human germ cells and embryos, help challenge the supposed permanent novelty of everything surrounding reproductive technologies and genetic interventions. Society is doubtless experiencing an open process in full innovation, but the social and symbolic effects on planning maternity, paternity, and filiation are still not well perceived or discussed. To illustrate such contradictions, the article focuses on the case of oocyte donation, highlighting the need for new perspectives in terms of social control over the dissemination of reproductive technologies.
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Affiliation(s)
- M V Corrêa
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, 20559-900, Brasil
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Gloria-Bottini F, Nicotra M, Lucarini N, Bottini E. Parental PGM(1)and gestational length of live-born infants from couples with primary repeated spontaneous abortions. Placenta 2000; 21:588-90. [PMID: 10940211 DOI: 10.1053/plac.1999.0506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Women's Health LiteratureWatch. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 1999; 8:1121-7. [PMID: 10565672 DOI: 10.1089/jwh.1.1999.8.1121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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