Maternal Vascular Health in Pregnancy and Postpartum After Assisted Reproduction

Abstract

Although most pregnancies after assisted reproduction are associated with a favorable outcome for the mother and infant, reports of abnormal vascular adaptation in early pregnancy and emerging maternal and perinatal pathology warrant further investigations. Herein we extended our previous work and further examined whether perturbations of blood pressure and endothelial function during the first trimester in conceptions with nonphysiological corpus luteum (CL) numbers would persist through the third trimester of pregnancy and into the postpartum period. We investigated both maternal and perinatal outcomes. Participants were grouped according to CL number and method of conception: 0 CL (programmed autologous frozen-thawed embryo transfer, N=10–18); 1 CL (spontaneous conception [N=16] and natural cycle frozen-thawed embryo transfer [N=12]); or >3 CL associated with autologous fresh embryo transfer [N=8–12]. Augmentation index was higher during the third trimester in the absence of a CL compared to 1 CL ( P =0.03) and in frozen-thawed embryo transfer in a programmed compared to a natural cycle ( P =0.02). Moreover, baseline pulse-wave amplitude was higher in >3 CL conceptions at all time points (all P <0.05). The incidence of preeclampsia and preeclampsia with severe features was significantly higher in the absence of a CL compared to the presence of one or >3 CL ( P =0.045 and P =0.03). Infants from conceptions with >3 CL had lower birth weights ( P =0.02) and a higher rate of low birth weight offspring ( P =0.008). Deficient vascular adaptation during early gestation in conceptions with nonphysiological CL numbers might predispose women to adverse pregnancy outcomes, for example, preeclampsia.

Perinatal and maternal outcome after vitrification of blastocysts: a Nordic study in singletons from the CoNARTaS group

“…A study on 184 women revealed undetectable serum relaxin concentrations in women where no CL was present . Furthermore, two smaller studies showed that the drop in mean arterial pressure was lacking in women with 0 or >3 CL and that the perturbations in blood pressure remained in the third trimester , von Versen-Hoynck et al, 2020. Finally, in a prospective cohort study on almost 700 women, programmed cycles in FET with no CL were associated with an almost 3-folded risk of preeclampsia compared to modified natural cycles with one CL .…”

“…However, prior history of hypertensive disease, an important confounder, have not been adjusted for in any of these studies except for the study by Farhi et al (2013). The reasons for the higher incidence of HDP following FET has not been clear but recent studies from the United States noted higher rates of preeclampsia in pregnancies lacking a CL , von Versen-Hoynck et al, 2020. Likewise, a large Japanese study on almost 8000 children following a natural cycle and 16,000 children following FET in programmed cycles, found a 40% increase in HDP following programmed cycles lacking a CL (Saito et al, 2019).…”

“…Since delivery is the only cure for the disorder, the placenta is considered to play a crucial role. Interestingly, four recently published studies reveal an association between the absence of CL in programmed cycles and HDP , von Versen-Hoynck et al, 2020. The CL, lacking in programmed cycles due to suppression of the pituitary-ovarian hormonal axis, is the sole source of relaxin in early pregnancy.…”

“…Four recent studies, investigating the association between physiological changes during pregnancy and pregnancy outcome to the presence/absence of CL revealed increased risks for abnormal vascular adaptation and preeclampsia in pregnancies lacking a CL , von Versen-Hoynck et al, 2020. The CL produces not only estrogen and progesterone but is also the sole source of relaxin in early pregnancy.…”

The freeze-all strategy after IVF: which indications?

“…This is in accordance with the recent observation that the risk of preeclampsia was increased in pregnancies achieved without the corpus luteum (CL), as in programmed frozen ET cycles (von Versen-Höynck et al, 2019). The lack of circulating angiogenic and immunoregulatory factors usually produced by the CL was suggested to be involved in this increase (Conrad et al, 2019), as a result of maternal abnormal vascular adaptation during early gestation that can lead to adverse obstetric outcomes (von Versen-Höynck et al, 2020). These results are also supported by the high rates of HDP reported in oocyte donation pregnancies (Blazquez et al, 2018;Storgaard et al, 2017), which were mostly obtained after HRT-cycles.…”