Materno-Fetal Cardiovascular Complications in Turner Syndrome after Oocyte Donation: Insufficient Prepregnancy Screening and Pregnancy Follow-Up Are Associated with Poor Outcome

Abstract

Context: Recombinant human GH treatment and oocyte donation (OD) have improved the quality of life in women with Turner syndrome (TS). However, life expectancy is reduced, mainly due to cardiovascular complications. Pregnancy may itself increase that risk and be associated with hazardous materno-fetal outcome. Objective: The objective of this study was to evaluate the materno-fetal outcome of ongoing pregnancies beyond 20 wk of gestation obtained by OD in TS. Design: This was a multicenter retrospective study including all assisted reproductive technology centers affiliated with the French Study Group for Oocyte Donation. Results: Among 93 patients, only 37.6% were prescreened with echocardiography or thoracic magnetic resonance imaging. Maternal outcome was dominated by 37.8% of pregnancy-associated hypertensive disorders including preeclampsia in 54.8% and severe eclampsia in four patients. Prematurity occurred in 38.3% and was correlated with PAHD (P = 0.01). The frequency of in utero growth retardation was 27.5%. One fetal demise was linked to eclampsia. Two patients died from aortic rupture after cesarean section in a context of aortic root dilatation. Only 40% of pregnancies were associated with an absolutely normal materno-fetal outcome. Conclusions: OD pregnancies in TS who have not been managed following recent specific recommendations were at high risk for maternal death by aortic dissection and for preeclampsia and its complications (fetal distress and in utero growth retardation). These recommendations include previous echocardiography, thoracic magnetic resonance imaging, and overnight blood pressure monitoring associated with a tight follow-up during pregnancy. Until future assessment of these recent recommendations, pregnancies obtained in TS after OD must be still considered as very high-risk pregnancies.

Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting

“…In many studies, the outcomes of singleton and multiple pregnancies are not reported separately, which make their interpretation difficult. The perinatal mortality rate has been reported between 0 and 11% in published studies (225,226,231,232,233).…”

“…In TS, the incidence of hypertensive disorders of pregnancy has been reported to be 35-67% in singleton pregnancies and as high as 100% in multiple pregnancies (222, 224, 225, 226, 231, 232, 233). The reported incidence of pre-eclampsia ranged between 18% and 44% in singleton pregnancies and 75-100% in multiples, while the cesarean section rate is as high as 82-100% (222, 224,225,226,231,232,233). In comparison, in oocyte recipients without TS, the rate of hypertensive disorders of pregnancy is 13-39%, and the cesarean section rate is 31-85% in singleton pregnancies (234).…”

Zaburzenia w budowie aorty u pacjentek z zespołem Turnera — nowe metody diagnostyki i leczenia

“…Increasing numbers of women with TS are seeking pregnancy with modern reproductive technologies [57]. However, this population with a high prevalence of cardiac malformations is considered as very high-risk pregnancies [61][62][63][64]. The overall risk for major pregnancy complications in TS women is approximately 10% and the risk of maternal death is approximately 3.5% [64].…”

“…Recent guidelines recommend a cardiovascular check-up before pregnancy [59]. Aortic diameters above 25 mm/ m 2 , aortic coarctation, and a history of aortic surgery are considered contraindications to pregnancy [59,63,64].…”

“…This was a multicentre retrospective study of about 20 years including all French centres that performed oocyte donation. 93 pregnancies with TS were included in analysis and two cases of aortic dissection were reported [63]. Another retrospective cohort study which included 106 women with TS who delivered after oocyte donation was performed in three Nordic countries (Finland, Denmark and Sweden) between 1992 and 2011.…”