Nuchal translucency measurement, freeβ-hCG and PAPP-A concentrations in IVF/ICSI pregnancies: systematic review and meta-analysis

Abstract

So far, data on the effect of assisted reproductive technologies (ART) on the components of first trimester combined screening for Down syndrome are still controversial. A systematic search of the literature was performed in order to identify the effect of ART, particularly in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) with fresh embryo transfer, on the nuchal translucency, free beta-human chorionic gonadotrophin and pregnancy-associated plasma protein-A measurements. Moreover, a meta-analysis and a descriptive graphical representation of the ratios between ART and spontaneous pregnancies (controls) values of median of the multiple of median (m MoM) were performed. Free beta-human chorionic gonadotrophin test showed slightly higher values in the ICSI group than controls (RR = 1.09, 95%CI: 1.03-1.16) but not in the IVF group (RR = 1.03, 95%CI: 0.94-1.12). Pregnancy-associated plasma protein-A values for IVF/ICSI, IVF and ICSI showed lower values in comparison with controls (RR, 95%CI 0.85, 0.80-0.90; 0.82, 0.74-0.89 and 0.83, 0.79-0.86, respectively). The nuchal translucency measurement did not show any statistical differences between study groups (IVF and ICSI) and controls (RR = 1.00, 95%CI: 0.94-1.08 and RR = 1.01, 95%CI: 0.97-1.05, respectively). These results may be due to alterations in the placentation of ART pregnancies. Differentiating further subgroups of ART pregnancies may explain the differences in biomarker concentrations, in prenatal behavior and in obstetric outcomes between ART and spontaneous pregnancies. © 2017 John Wiley & Sons, Ltd.

Prenatal Growth in Fetuses with Isolated Cyanotic and Non-Cyanotic Congenital Heart Defects

“…As suggested by Fantasia et al [23], normality of placental perfusion and only abnormally low pregnancy-associated plasma protein-A and placental growth factor in the first trimester of CHDs suggests mild and subclinical placental dysfunction. This result is coherent with the recent finding of increased risk of CHD in pregnancy after assisted reproductive technologies, which presents also lower placental hormones in the first trimester [24,25]. This may be associated with other contributors explaining altered development in all CHD fetal systems, including the heart, brain, and placenta [23,26,27].…”

Congenital heart defects in IVF/ICSI pregnancy: systematic review and meta‐analysis

“…A recent meta-analysis from our group showed that IVF/ICSI pregnancies present placental dysfunction with lower pregnancy-associated plasma protein A (PAPP-A) and higher free β-human chorionic gonadotropin concentrations in the first trimester 72 . Recent data also show that, in pregnancies with isolated major CHD, there is significantly lower PAPP-A and placental growth factor in the absence of impaired placental perfusion and increased risk of pre-eclampsia 73,74 .…”

Risk of spontaneous preterm birth in singleton pregnancies conceived after IVF/ICSI treatment: meta‐analysis of cohort studies

“…First‐trimester combined screening in IVF/ICSI pregnancies obtained after fresh embryo transfer shows increased concentrations of free β‐human chorionic gonadotropin and a reduction in pregnancy‐associated plasma protein‐A. These biomarkers indicate abnormal placentation and may be the biochemical precursors of anomalous outcomes described in IVF/ICSI pregnancies.…”