Perinatal complications and live-birth outcomes following assisted reproductive technology

Abstract

BackgroundWith the development of assisted reproductive technology (ART) and its increasing success rate in the mainland of China, more attention has been paid to the safety of ART. In this study, we explored the associations between conception by ART and pregnancy/perinatal complications, and neonatal outcomes compared with similar outcomes following spontaneous conception.MethodsThis retrospective cohort study of pregnancies over a 3-year period (2013–2015) was performed at Beijing Obstetrics and Gynecology Hospital, Beijing, China. Subjects were divided into two groups: conception by ART (n = 2256) or spontaneous conception (n = 6768). According to different fertilization modes, the ART group was divided into in vitro fertilization (IVF, n = 1873) and intracytoplasmic sperm injection (ICSI, n = 383) subgroups. The ART group was also divided into two different embryo transfer methods; fresh embryo transfer (ET, n = 1583) and frozen embryo transfer (FET, n = 673) subgroups. Pregnancy complications, perinatal complications, and neonatal outcomes of the enrolled subjects were investigated and analyzed by univariate analysis and multivariate logistic regression.ResultsAfter adjustment for maternal age, gravidity, parity, maternal education, smoking, alcohol consumption, and body mass index (BMI), pregnancies conceived by ART were associated with a significantly increased incidence of gestational diabetes mellitus (GDM; OR 1.88, 95% CI 1.56–2.27), gestational hypertension (OR 2.18, 95% CI 1.83–2.60), and intrahepatic cholestasis of pregnancy (ICP) (OR 2.79, 95% CI 2.15–3.64), compared with spontaneous conception. These associations were similar for the singleton group. In the twin group, only the incidence of ICP was significantly higher than in controls. We found that pregnancies conceived by ART were associated with perinatal complications, including placental abruption (OR 2.14, 95% CI 1.33–3.45), premature rupture of membranes (PROM; OR 1.24, 95% CI 1.06–1.45), postpartum hemorrhage (OR 2.89, 95% CI 2.33–3.59) and polyhydramnios (OR 2.01, 95% CI 1.29–3.16). The singleton group had a similar result with placental abruption, but not with fetal membranes ruptures before labor and polyhydramnios. There were no significant differences in the incidence of these perinatal complications in the twin group. Some neonatal outcomes, including preterm labor (OR 4.29, 95% CI 3.84–4.80) and low birth weight (OR 1.72, 95% CI 1.42–2.08), were more likely to occur with singleton births after ART. However, there were no significant differences for these outcomes from twin pregnancies. Perinatal complications and neonatal outcomes were consistent between the IVF and ICSI subgroups. The FET and ET subgroups showed a similar increase in complications, except for the incidence of placental abruption. After taking into account the effects of parity, birth plurality and maternal age, the ART group still exhibited increased maternal and neonatal complications, although some differences narrowed or disappeared.ConclusionsThis retro...

Maternal and child-health outcomes in pregnancies following Assisted Reproductive Technology (ART): a prospective cohort study

“…Similar to our findings, studies with larger sample sizes (conception by ART "n = 2256" and spontaneous conception "n = 6768") have demonstrated that patients who underwent ART were at increased risk for several adverse pregnancy outcomes compared to women who conceived spontaneously. These complications were attributed in part to the relatively higher multiple pregnancy rate after ART [20]. These findings were consistent with a prospective cohort study by Moini et al, suggesting that twin pregnancies are indeed an important factor leading to adverse outcomes.…”

Are morphokinetic parameters of embryo development associated with adverse perinatal outcomes following fresh blastocyst transfer?

“…Studies showing higher prevalence of poor outcomes in singleton IVF pregnancies compared with spontaneously conceived pregnancies (Lei et al, 2019;Sullivan-Pyke et al, 2017) have strengthened the need to identify additional parameters, with the aim of improving the ability to select embryos with the highest probability of implantation and good perinatal outcomes.…”

“…VF is considered a successful treatment for infertility and most children born following IVF treatment are healthy. However, in recent years it has been suggested that IVF and intracytoplasmic sperm injection (ICSI) pregnancies are associated with higher rates of adverse perinatal outcomes compared with spontaneously conceived pregnancies (Lei et al, 2019;Sullivan-Pyke et al, 2017). These outcomes have been attributed to the higher multiple pregnancy rates in IVF, as well as to the aetiology of infertility.…”

“…In order to reduce multiple pregnancies, a policy of single embryo transfer (SET) has been adopted. Still, despite the reduction in multiple pregnancies after IVF cycles, the rate of adverse outcomes, including gestational diabetes mellitus (GDM), hypertensive disorders of pregnancies, preterm delivery (PTD), low birthweight (LBW), congenital anomalies and neurodevelopmental disorders (Lei et al, 2019;Malchau et al, 2014;Qin et al, 2016) remains significantly higher (Silberstein et al, 2014). Some of these outcomes predispose the mother and the offspring to adverse outcomes, such as cardiovascular complications and diabetes, throughout their lives (Kessous et al, 2013b;Shah et al, 2008;Talaulikar and Arulkumaran, 2013).…”

Особливості Експресії Маркера Ендотеліальних Клітин Cd34 У Судинному Руслі Вілльозного Дерева Плаценти При Вагітності, Індукованій У Циклі Допоміжних Репродуктивних Технологій

“…Вагітність після ДРТ має більш високий ризик несприятливих акушерських ускладнень, включаючи гестаційний цукровий діабет, гестаційну гіпертензію, відшарування плаценти, передчасний розрив плодових оболонок, передчасні пологи, багатоводдя, багатопліддя, низьку масу тіла при народженні, уроджені вади розвитку, післяпологову кровотечу [5][6][7][8][9][10][11]. Зростаюча кількість доказів підтримує гіпотезу про те, що різні несприятливі наслідки вагітності, які спостерігаються після ДРТ, відбуваються через неоптимальну плацентацію, викликану аномальною функцією трофобласта [5,6,9].…”