Assisted reproductive technology and the risk of preeclampsia: an updated systematic review and meta-analysis

Almasi‐Hashiani, Amir; Omani-Samani, Reza; Mohammadi, Maryam; Amini, Payam; Navid, Behnaz; Alizadeh, Ahad; Morasae, Esmaeil Khedmati; Maroufizadeh, Saman

doi:10.1186/s12884-019-2291-x

Cited by 52 publications

(28 citation statements)

References 79 publications

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“…Our results of higher odds of HDP and preeclampsia in singleton pregnancies following IVF/ICSI were in accordance with other previous meta-analyses [ 7 , 10 , 13 , 14 ]. The measures of association for HDP in IVF/ICSI pregnancies (OR 1.70; 95% CI 1.60–1.80) was comparable to meta-analyses by Panday et al (RR 1.49; 95% CI 1.39–1.59) and Qin et al (RR 1.30; 95% CI 1.04–1.62) with a significant increase in statistical power due to a high number of studies included (51 studies) [ 7 , 14 ].…”

Section: Discussionsupporting

confidence: 93%

“…Although previous meta-analyses have shown that ART is associated with an increased risk of preeclampsia, the underlying mechanism is not well understood [ 13 , 14 ]. Many included studies were based on singleton pregnancies or mixed cohorts, while studies specifically comparing the risk of HDP in ART and spontaneous multiple pregnancies often yielded inconsistent results [ 9 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Assisted reproductive technology and hypertensive disorders of pregnancy: systematic review and meta-analyses

Chih

Elias

Gaudet

et al. 2021

BMC Pregnancy Childbirth

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Background Hypertensive disorders of pregnancy (HDP) is one of the most common pregnancy complications and causes of maternal morbidity and mortality. Assisted reproductive technology (ART) has been associated with adverse pregnancy outcomes, including HDP. However, the impact of multiple pregnancies, oocyte donation, as well as fresh and frozen embryo transfer needs to be further studied. We conducted a systematic review and meta-analyses to evaluate the association between ART and HDP or preeclampsia relative to spontaneous conception (SC). Methods We identified studies from EMBASE, MEDLINE, and Cochrane Library (up to April 8, 2020) and manually using structured search strategies. Cohort studies that included pregnancies after in vitro fertilization (IVF) with or without intracytoplasmic sperm fertilization (ICSI) relative to SC with HDP or preeclampsia as the outcome of interest were included. The control group was women who conceived spontaneously without ART or fertility medications. The pooled results were reported in odds ratios (OR) with 95% confidence intervals based on random effects models. Numbers needed to harm (NNH) were calculated based on absolute risk differences between exposure and control groups. Results Eighty-five studies were included after a screening of 1879 abstracts and 283 full text articles. Compared to SC, IVF/ICSI singleton pregnancies (OR 1.70; 95% CI 1.60–1.80; I2 = 80%) and multiple pregnancies (OR 1.34; 95% CI 1.20–1.50; I2 = 76%) were both associated with higher odds of HDP. Singleton pregnancies with oocyte donation had the highest odds of HDP out of all groups analyzed (OR 4.42; 95% CI 3.00–6.51; I2 = 83%). Frozen embryo transfer resulted in higher odds of HDP (OR 1.74; 95% CI 1.58–1.92; I2 = 55%) than fresh embryo transfer (OR 1.43; 95% CI 1.33–1.53; I2 = 72%). The associations between IVF/ICSI pregnancies and SC were similar for preeclampsia. Most interventions had an NNH of 40 to 100, while singleton and multiple oocyte donation pregnancies had particularly low NNH for HDP (16 and 10, respectively). Conclusions Our meta-analysis confirmed that IVF/ICSI pregnancies are at higher odds of HDP and preeclampsia than SC, irrespective of the plurality. The odds were especially high in frozen embryo transfer and oocyte donation pregnancies.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Assisted reproductive technology and hypertensive disorders of pregnancy: systematic review and meta-analyses

Chih

Elias

Gaudet

et al. 2021

BMC Pregnancy Childbirth

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“…There have been many debates on the efficacy and safety of using ART regarding its increasing trend of use across most countries [77,78]. It has been shown that ART is responsible for a high number of adverse pregnancyrelated complications and obstetric outcomes such as polyhydramnios, low and very low infant birth weight, pregnancy-induced hypertension, pre-eclampsia, perinatal mortality, preterm and very preterm birth, placenta [79][80][81][82][83]. As mentioned, using ART was associated with GDM, which is diabetes diagnosed during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Assisted reproductive technology and the risk of gestational diabetes mellitus: a systematic review and meta-analysis

Mohammadi

Morasae

Maroufizadeh

et al. 2020

Middle East Fertil Soc J

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Background: The use of assisted reproductive technology (ART) is increasing worldwide, and observational studies have indicated that women who conceived by ART have an increased risk of pregnancy complications including gestational diabetes mellitus (GDM). We aimed to determine the risk of GDM among women who conceived with ART by systematic review and meta-analysis. Main text: A systematic literature search was conducted in ISI Web of Knowledge, MEDLINE, Scopus, and Embase through May 2017 for English-language articles using a list of keywords. All studies comparing GDM in women conceived by ART and those who conceived spontaneously were included. Data extraction was performed by two authors independently and discrepancies were resolved by discussion. In total, 48 studies with 91,487 pregnancies conceived through ART and 2,525,234 spontaneously conceived met the inclusion criteria. There was evidence of substantial heterogeneity among these studies (P < 0.001, I 2 = 98.6%). Random effects meta-analysis showed a significant increase in GDM among those who conceived by ART compared with those who conceived spontaneously (pooled relative risk = 1.51, 95% confidence interval = 1.18-1.93). Visual inspection of the funnel plot did not reveal any publication bias, which was supported by Egger's test and Begg's test. Conclusion: The findings of this systematic review indicate that the use of ART treatment is associated with a 1.51fold increase in GDM. Women need to be counselled carefully before undergoing ART treatment about the possibility and risk of GDM.

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“…However, in the case of single pregnancies, several meta-analyzes showed an excess risk of prematurity (OR = 1.95; CI 1.73 -2.20) and of FGR (OR = 1.60; CI 1.25 -2.04) compared to naturally conceived pregnancies [11] [12]. An increased risk of pre-eclampsia (OR = 1.55 CI 1.23 -1.95) was also found [13]. A rate of 2.2% of ectopic pregnancy after IVF and 1.8% after natural conception was reported in USA [14].…”

Section: Introductionmentioning

confidence: 99%

Pregnancies Outcome after Assisted Reproductive Technology: A Multicenter Case Control Study in a Low Income Setting Douala, Cameroon

Charlotte¹,

Didier²,

Njamen³

et al. 2021

OJOG

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The objective was to assess the outcome of pregnancies after assisted reproductive technology (ART). It was a case-control study carried out in four health facilities in Douala-Cameroon, over a period of five years. The cases were pregnant women who conceived through ART and the controls were those who conceived naturally. Cases and controls were matched for maternal age and parity (one case for two controls). A logistic regression analysis was used to compute Odds ratios. Statistical significance was set at 0.05. A total of 174 women who conceived through ART and 348 who conceived naturally were enrolled. Some independent factors associated with ART were: age over 45 years [aOR: 7.55; 95% CI (1.55 -36.76); p: 0.01], twin pregnancies [aOR: 16.55; 95% CI (7.91 -34.60); p < 0.01], Cervical cerclage [aOR: 3.04; 95% CI (1.23 -7.50); p: 0.01], miscarriages [aOR: 11.73; 95% CI (5.07 -27.10); p: 0.01], elective cesarean section [aOR: 4.63; 95% CI (2.27 -9.45); p: 0.01] and low birth weight [aOR: 3.32; 95% CI (1.90 -5.82); p < 0.01]. Women who conceived by ART were older with higher rates of multiple pregnancy and complications. We recommend transfer of a single embryo.

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Assisted reproductive technology and the risk of preeclampsia: an updated systematic review and meta-analysis

Cited by 52 publications

References 79 publications

Assisted reproductive technology and hypertensive disorders of pregnancy: systematic review and meta-analyses

Assisted reproductive technology and hypertensive disorders of pregnancy: systematic review and meta-analyses

Assisted reproductive technology and the risk of gestational diabetes mellitus: a systematic review and meta-analysis

Pregnancies Outcome after Assisted Reproductive Technology: A Multicenter Case Control Study in a Low Income Setting Douala, Cameroon

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