Risk of preeclampsia following assisted reproductive technology: systematic review and meta-analysis of 72 cohort studies

Omani-Samani, Reza; Alizadeh, Ahad; Almasi‐Hashiani, Amir; Mohammadi, Maryam; Maroufizadeh, Saman; Navid, Behnaz; Morasae, Esmaeil Khedmati; Amini, Payam

doi:10.1080/14767058.2018.1560406

“…In line with our findings, previous studies have shown that subfertile women are at increased risk for PE (38)(39)(40)(41)(42). It is well recognised that pregnancies following ART are at higher risk for PE when compared with those after natural conception (43)(44)(45). Similar underlying causes may be behind PE and infertility.…”

Section: Discussionsupporting

confidence: 91%

The non-traditional and familial risk factors for preeclampsia in the FINNPEC cohort

Jaatinen

¹

,

Jääskeläinen

²

,

Finnpec³

et al. 2021

Pregnancy Hypertension

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Background Considering the burden of preeclampsia (PE), it is important to understand better the underlying risk factors involved in its etiology. In this nationwide study, we studied the association of background factors with PE with an emphasis on socioeconomic factors, reproductive factors and health history enclosing the parents of pregnant women. Methods In the Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) cohort participants filled in a questionnaire on background information including data on socioeconomic factors, health history and reproductive factors. The questionnaire data was available from 708 women with PE and 724 control women. Two different control groups, healthy controls with uncomplicated pregnancies (n=498) and all controls (n=724, including controls with uncomplicated pregnancies and pregnancy complications other than PE), were established. Background information among PE women and the two different control groups were compared. Results PE women had similar socioeconomic status and more often non-communicable diseases including type I diabetes, chronic hypertension and hyperlipidemia than the two control groups (p<0.05 for all). Depression was more common among PE women (11.4%) than among all controls (7.6%) (p=0.019). Subfertility (estimated by time to pregnancy) was more common among PE women (p=0.013 for healthy controls, p=0.019 for all controls). PE women had earlier menarche (p=0.001 for healthy controls, p=0.022 for all controls). Hypertension was more common in both parents of PE women (p<0.001), stroke in fathers (PE women 6.2 %, healthy controls 3.2 % (p=0.020) and all controls 3.5 % (p=0.022)) and diabetes in mothers (PE women 7.5 %, healthy controls 3.1 % (p=0.001) and all controls 4.3 % (p=0.012)). Mental disorders including depression were more common in mothers of PE women compared to controls (PE women 7.2 %, healthy controls 3.7 % (p=0.013) and all controls 3.9 % (p=0.007)). Conclusions In this Finnish nationwide FINNPEC cohort, PE women had similar socioeconomic status, more non-communicable diseases and depression, earlier menarche, more subfertility and more parental non-communicable diseases compared to controls. As a novel finding we found more mental disorders including depression in mothers of PE women.

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“…In line with our findings, previous studies have shown that subfertile women are at increased risk for PE (38)(39)(40)(41)(42). It is well recognised that pregnancies following ART are at higher risk for PE when compared with those after natural conception (43)(44)(45). Similar underlying causes may be behind PE and infertility.…”

Section: Discussionsupporting

confidence: 91%

The non-traditional and familial risk factors for preeclampsia in the FINNPEC cohort

Jaatinen

¹

,

Jääskeläinen

²

,

Laivuori

³

et al. 2019

Preprint

1

0

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Background Considering the burden of preeclampsia (PE), it is important to understand better the underlying risk factors involved in its etiology. In this nationwide study, we studied the association of background factors with PE with an emphasis on socioeconomic factors, reproductive factors and health history enclosing the parents of pregnant women. Methods In the Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) cohort participants filled in a questionnaire on background information including data on socioeconomic factors, health history and reproductive factors. The questionnaire data was available from 708 women with PE and 724 control women. Two different control groups, healthy controls with uncomplicated pregnancies (n=498) and all controls (n=724, including controls with uncomplicated pregnancies and pregnancy complications other than PE), were established. Background information among PE women and the two different control groups were compared. Results PE women had similar socioeconomic status and more often non-communicable diseases including type I diabetes, chronic hypertension and hyperlipidemia than the two control groups (p<0.05 for all). Depression was more common among PE women (11.4%) than among all controls (7.6%) (p=0.019). Subfertility (estimated by time to pregnancy) was more common among PE women (p=0.013 for healthy controls, p=0.019 for all controls). PE women had earlier menarche (p=0.001 for healthy controls, p=0.022 for all controls). Hypertension was more common in both parents of PE women (p<0.001), stroke in fathers (PE women 6.2 %, healthy controls 3.2 % (p=0.020) and all controls 3.5 % (p=0.022)) and diabetes in mothers (PE women 7.5 %, healthy controls 3.1 % (p=0.001) and all controls 4.3 % (p=0.012)). Mental disorders including depression were more common in mothers of PE women compared to controls (PE women 7.2 %, healthy controls 3.7 % (p=0.013) and all controls 3.9 % (p=0.007)). Conclusions In this Finnish nationwide FINNPEC cohort, PE women had similar socioeconomic status, more non-communicable diseases and depression, earlier menarche, more subfertility and more parental non-communicable diseases compared to controls. As a novel finding we found more mental disorders including depression in mothers of PE women.

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“…To date, we have not found any studies that that relate AKI to the use of assisted reproductive techniques in patients with SP, although there are studies that describe the relationship between AKI and assisted reproduction techniques in pregnant women in general [ 29 , 30 ]. What is well established is that preeclampsia is the most frequent cause of AKI in developed countries [ 13 , 21 , 23 , 24 , 31 , 32 ], and it is very likely that the established relationship between preeclampsia and assisted reproductive techniques justifies our results [ 33 , 34 , 35 , 36 ].…”

Section: Discussionmentioning

confidence: 87%

Maternal-Perinatal Variables in Patients with Severe Preeclampsia Who Develop Acute Kidney Injury

Rodríguez-Benítez

¹

,

Moreno

²

,

Barrecheguren

³

et al. 2021

JCM

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Introduction: At present, we are witnessing an increase in preeclampsia, especially the most severe forms, which are associated with an increased risk of maternal-perinatal morbidity and mortality. As a severity criterion, acute kidney injury (AKI) has been associated with a worse prognosis, and for this reason, the maternal and perinatal variables associated with AKI in patients with severe preeclampsia (SP) were analysed in this study. Methods: An observational, retrospective, single-centre study of patients with SP treated at a tertiary hospital between January 2007 and December 2018 was conducted. The case criteria based on the criteria established by the ACOG Practice Guidelines for Gestational Hypertension and Preeclampsia. AKI is considered when serum creatinine exceeds 1.1 mg/dL in a pregnant woman with previously normal renal function. In patients with existing chronic kidney disease (CKD), it is referred to as AKI if the baseline serum creatinine increases by 1.5 fold. Pregestational, gestational and postpartum variables were analysed up to 12 weeks postpartum using univariate and multivariate logistic regression analysis. Results: During the study period, 76,828 births were attended, and 303 pregnant women were diagnosed with SP. The annual incidence of SP increased gradually throughout the study period, reaching 1.79/100 births/year in 2018. Acute kidney injury (AKI) occurred in 24.8% of the patients. The multivariate analysis revealed an increased association with a history of previous CKD, the use of assisted reproductive techniques and caesarean section. Uric acid and thrombotic microangiopathy (TMA) had a high correlation with AKI. Indications for caesarean section are associated with AKI in SP. Regarding perinatal outcomes in cases of AKI, there was a higher percentage of neonates who required foetal lung maturation with steroids and an increased need for NICU admission. No case of maternal death was recorded; however, an increase in neonatal mortality was found among patients who did not develop AKI. After 12 weeks postpartum, 72 patients were referred to the nephrology consultation for persistent hypertension, proteinuria or renal failure. Conclusions: In preeclampsia, AKI is a common complication, especially among patients with a history of CKD, those who became pregnant using assisted reproduction techniques and those who delivered via caesarean section. The perinatal impact of AKI is mainly centred on a higher rate of NICU admission and a lower mortality rate. Among biochemical and haematological markers, the uric acid level prior to renal failure has a direct and significant correlation with the risk of AKI, as does the development of TMA in patients with preeclampsia. Therefore, the monitoring of renal function in cases of preeclampsia should be strict, and referral for a nephrology consultation may be necessary in some cases.

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Risk of preeclampsia following assisted reproductive technology: systematic review and meta-analysis of 72 cohort studies

Cited by 20 publications

References 94 publications

The non-traditional and familial risk factors for preeclampsia in the FINNPEC cohort

The non-traditional and familial risk factors for preeclampsia in the FINNPEC cohort

The non-traditional and familial risk factors for preeclampsia in the FINNPEC cohort

Maternal-Perinatal Variables in Patients with Severe Preeclampsia Who Develop Acute Kidney Injury

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