Obstetric and perinatal outcomes of singleton pregnancies conceived via assisted reproductive technology complicated by gestational diabetes mellitus: a prospective cohort study

Abstract

BackgroundGrowing evidence indicates that the risk of obstetric and perinatal outcomes is higher in women with assisted reproductive technology (ART). However, there is little known about pregnancy related complications and co-morbidity in gestational diabetes mellitus (GDM) following singleton pregnancies achieved by ART in comparison with spontaneous conception (SC).MethodsTwo hundred sixty singleton pregnant women conceived by ART and 314 pregnant women conceived by spontaneous conception (SC) were participated in this prospective cohort study. All participants were enrolled after GDM screening through one-step oral glucose tolerance test (OGTT) and then grouped into GDM and non-GDM groups. Women were followed for pregnancy outcomes including pregnancy-induced hypertension (PIH), preeclampsia, antepartum hemorrhage (APH), cesarean section (CS), preterm birth (PTB), intrauterine growth restriction (IUGR), being small or large for gestational age (SGA or LGA), macrosomia, low birth weight (LBW), respiratory distress, neonatal hypoglycemia, NICU admission and perinatal mortality from antenatal visits to delivery. Confounding factors were adjusted in logistic regression model in order to estimate adjusted odds ratios (aORs).ResultsAmong 260 ART and 314 SC, 135 and 152 women were GDM women, respectively. Higher maternal age and pre-gravid BMI, shorter duration of gestation and lower gestational weight gain were observed in GDM groups (ART-GDM and SC-GDM) compared to those of the SC group. ART-GDM group had a higher risk (95% confidence interval) of obstetric complications including PIH [aOR:7.04 (2.24–22.15)], preeclampsia [aOR:7.78 (1.62–37.47)], APH [aOR:3.46 (1.28–9.33)], emergency CS [aOR:2.64 (1.43–4.88)], and perinatal outcomes such as PTB [aOR:3.89 (1.51–10.10)], LBW [aOR:3.11 (1.04–9.30)] and NICU admission [aOR:4.36 (1.82–10.45)], as well as neonatal hypoglycemia [aOR: 4.91 (1.50–16.07)], compared to SC group. SC-GDM group showed a higher risk of PIH [aOR: 4.12 (1.31–12.89)], emergency CS [aOR: 2.01 (1.09–3.73] and LGA [aOR: 5.20 (1.07–25.20)], compared to SC group. Additionally, ART group had a higher risk of PIH [aOR: 3.46(1.02–11.68), preeclampsia 5.29 (1.03–27.09), and NICU admission [aOR: 2.53 (1.05–6.09)] compared to SC. Insulin requirement (41.8% vs. 25.7%) was significantly higher in ART-GDM group compared to SC-GDM group.ConclusionThe findings of this study suggest that GDM occurring after ART conception increases the risk of adverse obstetric and perinatal outcomes.

The placental transcriptome of the first-trimester placenta is affected by in vitro fertilization and embryo transfer

“…[61,62]. However, in most cases involving humans, no immediate abortion has been observed, and most women give birth successfully after IVF-ET, which supports the hypothesis that interference by IVF-ET can trigger a placental compensatory mechanism [63,64].…”

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

“…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.…”

Comparison of general maternal and neonatal conditions and clinical outcomes between embryo transfer and natural conception

“…The fallopian tube is the most common site of ectopic implantation [8] , and about 1.5-2.1% of patients with ectopic pregnancy have undergone IVF [7] . Our findings showed that the percentage of women with a history of ectopic pregnancy was higher in the ET group (15.3%) than in the NC group (2.7%), which may be associated with previous ectopic pregnancy, history of infertility, history of surgery or the use of intrauterine contraceptive device [9] .…”