Article

Obstetric outcome in women with subfertility

Obstetrics and Gynaecology, University of Aberdeen, Aberdeen, Scotland, United Kingdom
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.86). 05/2005; 112(5):632-7. DOI: 10.1111/j.1471-0528.2004.00489.x
Source: PubMed

ABSTRACT It has been suggested that a history of subfertility is associated with increased obstetric and perinatal risks. It is unclear if the cause is inherent characteristics in the women or the fertility treatment.
To compare the obstetric and perinatal risks of singleton pregnancies in women with a history of subfertility in comparison with the general population.
Population cohort.
Aberdeen, Scotland.
Cases were women attending the Fertility Clinic between 1989 and 1999 who subsequently went on to have singleton pregnancies. Controls included the general population of women who delivered singletons over the same period.
We performed a retrospective cohort study to investigate the obstetric outcome of singleton pregnancies in women with subfertility. The general population of women who delivered singletons over the same period served as controls.
Obstetric and perinatal complications in singleton pregnancies.
Maternity records were available for a total of 1437 subfertile women and 21,688 controls. Subfertile women were older [mean (SD) age: 31 (4.7) years vs 27 (5.4) years, P < 0.01] and more likely to be primiparous (70% vs 65%, P < 0.001). After adjusting for age and parity, subfertile women were at increased risk of pre-eclampsia (OR 1.9, 95% CI 1.5-2.5), placenta praevia (OR 3.9, 95% CI 2.2-7.0) and placental abruption (OR 1.8, 95% CI 1.1-3.0), and more likely to undergo induction of labour (OR 1.5, 95% CI 1.3-1.6), caesarean section (OR 2.1, 95% CI 1.8-2.4) and instrumental delivery (OR 2.2, 95% CI 1.8-2.6), and deliver low birthweight (OR 1.4, 95% CI 1.3-1.7) and preterm (OR 1.7, 95% CI 1.2-2.2) infants. There were no differences between treatment-related and treatment-independent pregnancies.
Subfertile women are at higher risk of obstetric complications, which persist after adjusting for age and parity.

0 Followers
 · 
80 Views
  • Source
    • "The reason for the differences in the obstetric outcomes in spontaneous pregnancies and pregnancies with either fresh or frozen embryo transfers is unclear. Several factors related to the reproductive laboratory technology itself (De Geyter et al., 2006; Ombelet et al., 2006; Shih et al., 2008; Pelinck et al., 2010a,b; Nelissen et al., 2012; Makinen et al., 2013) or the patient characteristics (Thomson et al., 2005; Romundstad et al., 2008) may be involved. One of the factors possibly affecting pregnancy outcomes is COH, which causes a supraphysiologic endocrine uterine environment and suboptimal endometrial development (Hansen et al., 2002; Chung et al., 2006; Kalra et al., 2011; Kansal Kalra et al., 2011), which may finally result in adverse obstetric outcomes (Hansen et al., 2002; Chung et al., 2006; De Geyter et al., 2006; Ombelet et al., 2006; Wennerholm et al., 2009; Pelinck et al., 2010a,b). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Are there differences in estrogen and progesterone secretion in singleton pregnancies, up to Week 11, between spontaneous pregnancies, after controlled ovarian hyperstimulation and fresh embryo transfer (COH + ET) and after frozen embryo transfer in a spontaneous cycle (FET)?
    Human Reproduction 09/2014; 29(11). DOI:10.1093/humrep/deu223 · 4.59 Impact Factor
  • Source
    • "On sait que l'infertilité est en elle-même un facteur de risque de complications obsté tricales telles que les accouchement pré maturé s (Odd ratio [OR] = 1,38 [1,25–1,54]), le retard de croissance intra-uté rin (RCIU) (OR = 1,24 [1,16–1,45]), le petit poids de naissance (Odd ratio ajusté [aOR] = 1,4 [1,1–1,7]), la pré e ´ clampsie (aOR = 1,9 [1,4–2,5]), le placenta praevia (aOR = 3,9 [2,2–7,0]) ou encore le dé collement placentaire (aOR = 1,8 [1,1–3,0]) [9] [10] [11]. Il semble e ´ galement y avoir une augmentation significative des risques d'induction du travail (aOR = 1,5 [1,3–1,6]), d'extraction instrumentale (aOR = 2,2 [1,8–2,6]) et de cé sarienne (aOR = 2,1 [1,8–2,4]) [10] [11]. Il est lé gitime de se demander si l'endomé triose est un facteur de risque surajouté de complications obsté tricales. "
    [Show abstract] [Hide abstract]
    ABSTRACT: While association between endometriosis and infertility is well established, there are few studies about the impact of endometriosis on adverse pregnancy outcomes. The aim of this study was to determine the effect of endometriosis on obstetric outcomes and whether the severity of the disease had an influence on these. We performed a retrospective study to investigate the obstetric outcomes of a population of 1204 subfertile women, including 258 with endometriosis, who obtained, thanks to assisted reproduction technology, a singleton pregnancy evolving beyond embryonic stage. Two analyzes were performed. The first compared women with endometriosis to women with other causes of infertility. The second observed adverse pregnancy outcomes according to AFS-R stages of endometriosis. The overall rate of live birth children was 95.8%. In case of endometriosis, there was a significant increase of the incidence of preterm delivery, especially before 32weeks amenorrhea (6.2% vs 3.1% in the group "without endometriosis", P=0.03), antenatal bleeding (5.3% vs 2.2%, P=0.01) and placenta previa (4.9% vs 0.9%, P<0.0001). The incidence of gestational diabetes was significantly decreased (0.4% vs 2.7%, P=0.04). There was no correlation between endometriosis and cesarean section or preeclampsia, or between the AFS-R stage and adverse pregnancy outcomes. Endometriosis is a factor of obstetrical risk, independently of the infertility it causes. The AFS-R score does not seem to be representative of obstetric outcomes beyond first trimester of pregnancy for women with endometriosis.
    Gynécologie Obstétrique & Fertilité 03/2014; · 0.58 Impact Factor
  • Source
    • "In addition, infertile women are known to have an increased prevalence of cardiovascular disease (Parikh et al., 2012), depression (Wilkins et al., 2010) and certain types of reproductive cancers, such as uterine cancer (Brinton et al., 2005). Investigations into perinatal effects of subfertility have revealed that compared with the general population, spontaneously conceiving subfertile women are at risk for hypertension, pre-eclampsia, antepartum hemorrhage and other labor complications, as well as bearing infants preterm or with LBWs (Thomson et al., 2005; Jaques et al., 2010). Additionally, one study revealed that the prevalence of congenital malformation is positively correlated with increased time to pregnancy (Zhu et al., 2006). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Since the birth of the first IVF-conceived child in 1978, the use of assisted reproductive technologies (ART) has grown dramatically, contributing to the successful birth of five million individuals worldwide. However, there are several reported associations of ART with pregnancy complications, such as low birth weight, preterm birth, birth defects, epigenetic disorders, cancer, and poor metabolic health. Whether this is attributed to ART procedures or to the subset of the population seeking ART remains controversial, but the most relevant question today concerns the potential long-term implications of assisted conception. Recent evidence has emerged suggesting that ART-conceived children have distinct metabolic profiles that may predispose to cardiovascular pathologies in adulthood. Because the eldest IVF individuals are still too young to exhibit components of chronic middle-aged syndromes, the use of animal models has become particularly useful in describing the effects of unusual or stressful preimplantation experiences on adult fitness.Elucidating the molecular mechanisms by which embryos integrate environmental signals into development and metabolic gene expression programs will be essential for optimizing ART procedures such as in vitro culture conditions, embryo selection, and transfer. In the future, additional animal studies to identify mechanisms underlying unfavorable ART outcomes, as well as more epidemiological reviews to monitor the long-term health of ART children are required, given that ART procedures have become routine medical practice.
    Molecular Human Reproduction 12/2012; 19(4). DOI:10.1093/molehr/gas066 · 3.48 Impact Factor
Show more

Preview

Download
0 Downloads