Incidence and risk factors for velamentous umbilical cord insertion in singleton pregnancies after assisted reproductive technology

Abstract

Aim Assisted reproductive technology (ART) is gaining popularity worldwide. However, it is associated with increased incidence of velamentous umbilical cord insertion (VCI) in the placenta, resulting in adverse perinatal outcomes. This study aimed to identify the risk factors that might affect the incidence of VCI in pregnancies after ART treatment. Methods We retrospectively analyzed the records of 906 singleton pregnancies via ART; all women delivered in our facility. Three ART‐related variables and infant sex were examined: (1) fertilization method (conventional in vitro fertilization or intracytoplasmic sperm injection), (2) type of embryo at the time of transfer (fresh or frozen–thawed), (3) developmental stage of embryo at the time of transfer (cleavage stage or blastocyst), and (4) infant sex (male or female). Logistic regression analysis was used to assess the impact of these variables on the incidence of VCI. Results Of 906 cases, 55 had VCI (incidence rate, 6.1%). After adjusting for potential confounders, blastocyst stage of development (adjusted odds ratio [aOR]: 4.3, 95% confidence interval [CI]: 1.9–12.7) and female sex (aOR: 2.2, 95% CI: 1.2–3.9) emerged as independent risk factors for the development of VCI. The fertilization method and type of embryo at the time of transfer did not affect the incidence of VCI. Conclusions Blastocyst stage of development and female sex pose a higher risk for developing VCI. Thus, more attention should be paid to pregnancies achieved by blastocyst and with a female fetus to detect VCI proactively and safeguard the health of both mother and fetus/neonate.

Assisted Reproductive Technique and Abnormal Cord Insertion: A Systematic Review and Meta-Analysis

“…The study selection scheme is illustrated in Figure 1 . Overall, 1463 studies were examined, and 16 studies (37,128 ART pregnancies and 1,597,784 non-ART pregnancies) met the inclusion criteria for the descriptive analysis [ 7 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. As the two studies reported by Ebbing et al [ 33 , 35 ] used overlapping data (same database), the outcome of interest was different between them.…”

“…The risk of bias assessment for the included studies is presented in Supplemental Table S2 . Of those ( n = 16), a possible moderate publication bias (moderate quality) in 10 studies [ 7 , 29 , 30 , 31 , 33 , 34 , 35 , 36 , 37 , 38 ] and severe publication bias (low quality) in the other six studies [ 25 , 26 , 27 , 28 , 32 , 39 ] were observed.…”

“…The metadata of the 16 included studies are summarized in Supplemental Table S3 . Among eligible studies ( n = 16), the year of publication was between 1990 and 2021, and all studies were retrospective [ 7 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. No prospective studies or randomized controlled trials have been identified.…”

“…Two studies included only twin pregnancies [ 32 , 37 ]. Among the eligible studies ( n = 16), approximately half were from Europe ( n = 7, 43.8%) [ 32 , 33 , 35 , 36 , 37 , 38 , 39 ], followed by Japan ( n = 3, 18.8%) [ 25 , 31 , 34 ], the United States ( n = 3, 18.8%) [ 26 , 28 , 30 ], Canada ( n = 2, 12.5%) [ 7 , 27 ], and China ( n = 1, 6.3%) [ 29 ].…”

Effect Analysis of Degranulated Cell in Early Fertilization on FET Outcome and Offspring Safety with Data Mining

“…Interventions in the reproductive process during the most critical and vulnerable period of life formation, i.e., fertilization and early embryonic development, will more or less affect the development of gametes and embryos. And it may be stably transmitted during cell lysis and embryonic development, thereby affecting the health of offspring and even the next generation [ 6 , 7 ]. ART obtains more high-quality oocytes through controlled superovulation.…”