Preeclampsia and eclampsia in parturients from the in vitro fertilization program

Hypertensive pathologies and egg donation pregnancies: Results of a large comparative cohort study

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.

Assisted reproductive technology and pregnancy-related hypertensive complications: a systematic review

Hypertensive complications in pregnancy are the leading cause of maternal morbidity, at least in the developed countries. In recent years, infertility issues are managed with ever growing therapeutic options namely assisted reproductive technologies (ART), which improve the ratio of successful induction of pregnancy. It is still debated whether various ART modalities are associated with adverse pregnancy outcomes, including hypertensive complications, particularly with higher incidence of preeclampsia. The main source of controversy stems from the diversity of effect modifiers modulating the association between ART-oriented pregnancy and hypertensive disorders. Indeed, women undergoing an ART procedure are affected by diverse causes of infertility, are frequently characterized by different genetic patterns with respect to their artificially conceived embryo and experienced multiple gestations. In order to investigate whether ART modalities are associated with increased incidence of hypertensive complications in pregnancy, we reviewed all published studies carried out before the end of 2010 and identified in the PubMed database. Among the 47 studies finally selected and by acknowledging the potential of shortcomings related to the different study design and populations, the overall evidence suggests that ART-oriented pregnancies-especially the in-vitro fertilization techniques-are accompanied by increased risk for gestational hypertension and preeclampsia as compared with non-ART pregnancies, even after adjustment for confounders. Multiple gestations, advanced age and underlying polycystic ovary syndrome resulted in constant confounders of the questioned association. Reducing multiple gestations by implementing single embryo techniques might be the therapeutic limiting step to lower the rate of hypertensive complications in assisted pregnancies.

[Labour after intracytoplasmic sperm injection]

INTRODUCTION

The aim of our study was to describe labour characteristics after intracytoplasmic sperm injection programme. This is the first study of those deliveries at the Department of Gynecology and Obstetrics in Novi Sad.

PATIENTS AND METHODS

Subjects were 73 parturients and their babies from the intracytoplasmic sperm injection programme (48 singletons, 22 twins and 3 triplets), delivered from January 1st, 2001 to December 31st, 2006.

RESULTS

At the Department of Gynecology and Obstetrics in Novi Sad, 0.65% of all deliveries are those from assisted reproductive programmes. 30.67% of all labours after assisted reproductive programmes are after intracytoplasmic sperm injection. One half of all labours after intracytoplasmic sperm injection are twins. The mean age of women is 33-34. More than 95% of all babies were delivered by Cesarean section.

DISCUSSION

The most frequent pathologies in labours after intracytoplasmic sperm injection are hypertensive disorders and premature rupture of membranes. There is still a matter of debate what is a real cause for those pathologies, especially for hypertension (age of woman, laboratory factors and or induction of ovulation).

CONCLUSION

At the Department of Gynecology and Obstetrics in Novi Sad, one third of all deliveries after assisted reproductive programme are after intracytoplasmic sperm injection. The most frequent pathologies after intracytoplasmic sperm injection are hypertensive disorders, which is similar to findings of other authors. The mean age of women is also similar to the mean European age of women after intracytoplasmic sperm injection.