Obstetric outcome in donor oocyte pregnancies: a matched-pair analysis

Stoop, Dominic; Baumgarten, Miriam; Haentjens, Patrick; Polyzos, Nikolaos P.; Vos, Michel De; Verheyen, Greta; Camus, Michel; Devroey, Paul

doi:10.1186/1477-7827-10-42

Cited by 82 publications

(70 citation statements)

References 37 publications

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“…However, it has become clear that OD pregnancy is associated with an increased risk of gestational hypertension, preeclampsia, preterm birth, low birth weight, bleeding complications, and miscarriage compared with natural pregnancy or IVF pregnancy [1,7,16,24,28,29,35,38,49,59,64,68,69,78,80].…”

Section: Introductionmentioning

confidence: 98%

A new era in reproductive medicine: consequences of third-party oocyte donation for maternal and fetal health

et al. 2016

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The fetus is a semi-allograft for the maternal host in natural pregnancy, but the fetus is a complete allograft after oocyte donation (OD), and there is greater antigenic dissimilarity with the mother. Thus, OD pregnancy is a good model for understanding how the fetus is protected by the maternal immune system. Recent clinical data have revealed a higher risk of miscarriage, gestational hypertension, preterm birth, and low birth weight with OD pregnancy. There is also a higher incidence of chorionic deciduitis, dense fibrinoid deposits in the chorionic basal plate, inflammatory lesions in the chorionic plate, and C4d deposition on syncytiotrophoblasts in OD pregnancy. Impaired accumulation of T cells, regulatory T (Treg) cells, natural killer (NK) cells, and monocytes in the decidua basalis and poor remodeling of spiral arteries are observed in OD pregnancy irrespective of whether preeclampsia occurs. These findings may partly explain why OD pregnancy is associated with a high risk of gestational hypertension and preeclampsia. We need to clarify the immunological and pathological differences between uncomplicated and complicated OD pregnancy. In uncomplicated OD pregnancy, the level of HLA match between mother and baby is significantly higher than would be expected by chance, suggesting that miscarriage may be frequent with marked HLA mismatch. This review discusses the relationship between various aspects of the immune system and complications of OD pregnancy.

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Section: Introductionmentioning

confidence: 98%

A new era in reproductive medicine: consequences of third-party oocyte donation for maternal and fetal health

et al. 2016

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“…However, pregnancies achieved with donated oocytes are associated with a high incidence of first trimester bleeding and a 2-to 3-fold higher risk of gestational hypertension and pre-eclampsia when compared with conventional IVF (Serhal and Craft, 1989;Abdalla et al, 1998;Sö derstrom-Anttila et al, 1998;Yaron et al, 1998;Klein and Sauer, 2002;Sheffer-Mimouni et al, 2002;Wiggins and Main 2005;van der Hoorn et al, 2010;Stoop et al, 2012). The incidences of intrauterine growth restriction, preterm birth (PTB) and birth defects have mostly been comparable with conventional IVF (van der Hoorn et al, 2010), although impaired fetal growth in OD pregnancies when compared with conventional IVF has been noted (Gibbons et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Obstetric and neonatal outcome after oocyte donation in 106 women with Turner syndrome: a Nordic cohort study

et al. 2013

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summary answer: Pregnancies among women with TS carry a substantial risk, particularly for hypertensive disorders. Potentially lifethreatening complications occurred in 3.3% of pregnancies. The neonatal outcomes were generally reassuring, with similar rates of preterm birth and low birthweight (LBW) as after conventional IVF and better than previously reported in deliveries after OD in women with TS.what is known already: OD pregnancies in women with TS are known to be high-risk pregnancies. study design, size, duration: This retrospective cohort study included 106 women with TS who delivered after OD (n ¼ 122 deliveries, n ¼ 131 newborns) in three Nordic countries (Finland, Denmark, Sweden) between 1992 and participants, setting and methods: Women with TS who delivered after OD in three Nordic countries were identified (n ¼ 110). Four women declined to participate or were lost to follow-up, thus 106 women were included in the study. The medical data from fertility clinics, antenatal clinics and the hospitals where the women had been treated and/or delivered were scrutinized.main results and the role of chance: In this cohort, the karyotype was 45,X in 44% of the women with TS. Ten women (9.4%) had a known cardiac defect before pregnancy. Single embryo transfer was performed in 70.3% of the cases and the multiple birth rate was 7.4%. In total, 35.0% of the pregnancies were associated with a hypertensive disorder including pre-eclampsia in 20.5%. Potentially lifethreatening complications occurred in four pregnancies (3.3%), including one woman with aortic dissection, one with mild regurgitation of the tricuspid and mitral valve, one with a mechanical heart valve who developed HELLP syndrome (haemolysis, elevated liver enzymes, low platelets) and one who underwent a post-partum hysterectomy due to severe haemorrhaging. Neonatal outcomes were reassuring, with a preterm birth rate of 8.0% and LBW rate of 8.8% in singletons. Major birth defects were found in 3.8% of the children. The perinatal mortality was 2.3% (3/131), including a set of extremely preterm twins.limitations, reasons for caution: Although this study was performed over a period of almost 20 years in three different countries, with a low drop-out rate and little missing data, much larger series are needed to assess rare events. This study also lacks an appropriate control group. Reproduction, Vol.28, No.6 pp. 1598-1609, 2013 Advanced Access publication on March 27, 2013 doi:10.1093/humrep/det082 Downloaded from https://academic.oup.com/humrep/article-abstract/28/6/1598/605487 by guest on 07 June 2019 wider implications of the findings: This study suggests that cardiovascular evaluation before and during pregnancy may contribute to favourable obstetric outcomes in many cases. Maternal outcomes were in agreement with the literature while neonatal outcomes were generally better than previously reported. The outcomes were consistent across the three countries, supporting generalizability to similar populations.

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“…We performed subgroup analysis for four studies with twin pregnancies, and the fixed‐effect model showed that hypertensive disorders of pregnancy were significantly higher in DO twin pregnancy than in the autologous twin pregnancy group [ n / N = 89/229 (38%) versus n / N = 948/5630 (16%), OR 3.69, 95% CI 2.62–5.19, I 2 = 0%; Figure ]. The subgroup analysis for PET in singleton DO pregnancies included four studies, and the fixed‐effect model showed that the risk of PET was significantly higher in singleton DO pregnancy [ n / N = 66/606 (10%) versus n / N = 333/10193 (3%), OR 2.90, 95% CI 1.98–4.24, I 2 = 0%; Figure ]. The fixed‐effect model meta‐analysis of five studies showed that the risk of PIH in singleton DO pregnancy is significantly higher when compared with singleton IVF pregnancy [ n / N = 99/577 (17%) versus n / N = 522/10211 (5%), OR 3.08, 95% CI 2.26–4.19, I 2 = 0%; Figure ] .…”

Section: Resultsmentioning

confidence: 99%

“…The subgroup analysis for PET in singleton DO pregnancies included four studies, and the fixed‐effect model showed that the risk of PET was significantly higher in singleton DO pregnancy [ n / N = 66/606 (10%) versus n / N = 333/10193 (3%), OR 2.90, 95% CI 1.98–4.24, I 2 = 0%; Figure ]. The fixed‐effect model meta‐analysis of five studies showed that the risk of PIH in singleton DO pregnancy is significantly higher when compared with singleton IVF pregnancy [ n / N = 99/577 (17%) versus n / N = 522/10211 (5%), OR 3.08, 95% CI 2.26–4.19, I 2 = 0%; Figure ] . Additionally, the subgroup analysis fixed‐effect model of two studies of women older than 40 years of age showed that the risk for hypertensive disorders was still significantly higher with DO pregnancy compared with IVF pregnancy [ n / N = 30/129 (23%) versus n / N = 18/168 (10%), OR 2.33, 95% CI 1.21–4.49, I 2 = 2%; Figure ] .…”

Section: Resultsmentioning

confidence: 99%

Donor oocyte conception and pregnancy complications: a systematic review and meta‐analysis

Jeve

Potdar

Opoku

et al. 2016

BJOG

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Background Observational studies showed that women with a donor oocyte (DO) pregnancy have an increased risk of pregnancy complications.Objectives Systematic review and meta-analysis to compare pregnancy complications of DO pregnancy with autologous oocyte in vitro fertilisation (IVF), and whether DO pregnancy acts as an independent risk factor.Search strategy Online searches of databases from 1 January 1980 to 31 January 2015 were performed using a set of relevant keywords.Selection criteria All studies comparing pregnancy complications of women with donor oocyte IVF and autologous oocyte IVF were included.Data collection and analysis Data collected included demographics and pregnancy complications. Methodological quality assessment was performed using the Newcastle-Ottawa scale. Statistical analysis was performed using REVIEW MANAGER 5.3 and STATA 13.0. Meta-regression was performed for age.Main results In total, 11 studies (n = 81 752) were included. Ten studies (n = 11 539) examined the primary outcome. The risk of developing hypertensive disorders in pregnancy was significantly higher for DO pregnancy (odds ratio, OR 3.92; 95% confidence interval, 95% CI 3.21-4.78). Further subgroup analysis for singleton and twin pregnancies showed that the risk was significantly higher for DO pregnancy in each group. Secondary outcomes including small for gestational age (OR 1.81), caesarean section (OR 2.71), and preterm delivery (OR 1.34) were significantly higher with DO pregnancy. Meta-regression for the covariate of age suggested that risk was independent of age.Author's conclusions Donor oocyte pregnancy acts as an independent risk factor for pregnancy complications, including hypertensive disorders, small for gestational age, and preterm delivery. Women should be counselled carefully before undergoing DO-assisted conception.Keywords Donor oocyte pregnancy, in vitro fertilisation, preelampsia, pregnancy-induced hypertension.Tweetable abstract Donor oocyte conception is an independent risk factor for obstetric complications.

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Obstetric outcome in donor oocyte pregnancies: a matched-pair analysis

Cited by 82 publications

References 37 publications

A new era in reproductive medicine: consequences of third-party oocyte donation for maternal and fetal health

A new era in reproductive medicine: consequences of third-party oocyte donation for maternal and fetal health

Obstetric and neonatal outcome after oocyte donation in 106 women with Turner syndrome: a Nordic cohort study

Donor oocyte conception and pregnancy complications: a systematic review and meta‐analysis

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