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Risk of Ischemic Placental Disease Is Increased Following in Vitro Fertilization with Oocyte Donation: a Retrospective Cohort Study

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Risk of Ischemic Placental Disease Is Increased Following in Vitro Fertilization with Oocyte Donation: a Retrospective Cohort Study Journal of Assisted Reproduction and Genetics (2019) 36:1917–1926 https://doi.org/10.1007/s10815-019-01545-3 ASSISTED REPRODUCTION TECHNOLOGIES Risk of ischemic placental disease is increased following in vitro fertilization with oocyte donation: a retrospective cohort study Anna M. Modest1,2 & Katherine M. Johnson1 & S. Ananth Karumanchi3,4 & Nina Resetkova5 & Brett C. Young1 & Matthew P. Fox2,6 & Lauren A. Wise2 & Michele R. Hacker1,7 Received: 23 May 2019 /Accepted: 23 July 2019 /Published online: 29 July 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Purpose Assess the risk of ischemic placental disease (IPD) among in vitro fertilization (IVF; donor and autologous) pregnancies compared with non-IVF pregnancies. Methods This was a retrospective cohort study of deliveries from 2000 to 2015 at a tertiary hospital. The exposures, donor, and autologous IVF, were compared with non-IVF pregnancies and donor IVF pregnancies were also compared with autologous IVF pregnancies. The outcome was IPD (preeclampsia, placental abruption, small for gestational age (SGA), or intrauterine fetal demise due to placental insufficiency). We defined SGA as birthweight < 10th percentiles for gestational age and sex. A secondary analysis restricted SGA to < 3rd percentile. Results Of 69,084 deliveries in this cohort, 262 resulted from donor IVF and 3,501 from autologous IVF. Compared with non- IVF pregnancies, IPD was more common among donor IVF pregnancies (risk ratio (RR) = 2.9; 95% CI 2.5–3.4) and autologous IVF pregnancies (RR = 2.0; 95% CI 1.9–2.1), adjusted for age and parity. IVF pregnancies were more likely to be complicated by preeclampsia (donor RR = 3.8; 95% CI 2.8–5.0 and autologous RR = 2.2; 95% CI 2.0–2.5, adjusted for age, parity, and marital status), placental abruption (donor RR = 3.8; 95% CI 2.1–6.7 and autologous RR = 2.5; 95% CI 2.1–3.1, adjusted for age), and SGA (donor RR = 2.7; 95% CI 2.1–3.4 and autologous RR = 2.0; 95% CI 1.9–2.2, adjusted for age and parity). Results were similar when restricting SGA to < 3rd percentile. Conclusion Pregnancies conceived using donor IVF and autologous IVF were at higher risk of IPD and its associated conditions than non-IVF pregnancies and associations were consistently stronger for donor IVF pregnancies. Keywords Autologous oocyte . Donor oocyte . Ischemic placental disease . Placental abruption . Preeclampsia . Small for gestational age Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10815-019-01545-3) contains supplementary material, which is available to authorized users. * Anna M. Modest 4 Department of Medicine, Cedars-Sinai Medical Center, 8700 [email protected] Beverly Blvd, Los Angeles, CA 90048, USA 5 1 Department of Obstetrics and Gynecology, Beth Israel Deaconess Boston IVF, 130 2nd Avenue, Waltham, MA 02451, USA Medical Center/Harvard Medical School, 330 Brookline Avenue, KS 3, Boston, MA, USA 6 Department of Global Health, Boston University School of Public 2 Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA Health, 715 Albany Street, Boston, MA 02118, USA 7 3 Center for Vascular Biology Research, Beth Israel Deaconess Department of Epidemiology, Harvard T.H. Chan School of Public Medical Center/Harvard Medical School, 99 Brookline Avenue, RN Health, 677 Huntington Avenue, Boston, MA 02115, USA 359, Boston, MA 02215, USA 1918 J Assist Reprod Genet (2019) 36:1917–1926 Introduction Methods Ischemic placental disease (IPD), defined as preeclampsia, Study population placental abruption, and/or small for gestational age (SGA), affects 16–23% of pregnancies in the USA [1–3]. These three We included all deliveries of live-born infants and intrauterine conditions can occur separately; however, they often co-occur fetal demise (IUFD) at or after 20 weeks of gestation from andhavesharedriskfactors[2, 3]. The etiology of IPD is not January 1, 2000, to June 1, 2015, at Beth Israel Deaconess well understood, but most hypotheses postulate that abnormal Medical Center (BIDMC), a large tertiary care hospital. We placentation plays a role [4–6]. Specifically, insufficient pla- excluded deliveries to mothers less than 18 years of age. This centation, or failure of the trophoblasts to properly invade the study was approved by the institutional review boards at Beth placental bed, is believed to be the pathogenesis for IPD [6, 7]. Israel Deaconess Medical Center and the Massachusetts IPD contributes to more than half of all medically indicated Department of Public Health. A summary of data sources used deliveries before 35 weeks of gestation [3] and half of all for this study is included in Appendix Table S1. preterm births [7]. Several risk factors for IPD have been identified, including Exposure advanced maternal age, nulliparity, multiple gestations, chron- ic hypertension, diabetes (prior to pregnancy and gestational), We evaluated three exposure groups: donor IVF, autologous and a history of one of the conditions of IPD [3, 6, 8–10]. More IVF, and non-IVF (reference). Women undergoing either type recently, in vitro fertilization (IVF) has been found to increase of IVF could use partner or donor sperm. Oocyte source was the risks of preeclampsia [6, 8, 10–16]andSGAbyupto60% abstracted through electronic medical records at Boston IVF, [13, 17, 18]. In addition, IVF pregnancies have been found to BIDMC’s affiliated infertility treatment center, or through the have up to five times the risk of placental abruption [8, 11, 12]. birth certificate data from the Massachusetts Department of Studies assessing differences between IVF using a donated Public Health. oocyte and IVF using the woman’s own oocytes have been Given there was no unique identifier that linked IVF cycles mixed in their methodology and subsequent findings [6, 8, 14, and deliveries, we employed a multi-step approach to match 19, 20]. Some have suffered from small sample size, and IVF cycles and deliveries using maternal last name, date of others have varying comparison groups (such as spontaneous birth, and time of conception. First, all IVF cycles (fresh and conceptions or autologous IVF). In addition, prior studies have frozen) performed at Boston IVF from January 1, 1999, to combined outcomes that may not have a shared biological June 1, 2015, with a confirmed clinical pregnancy were iden- mechanism, such as pregnancy-induced hypertension and pre- tified electronically using clinic-specific procedure codes for eclampsia. Although the mechanism behind the increased risk IVF type. IVF cycles that ended in an ectopic pregnancy, of IPD is not clear, one hypothesis pertains to the maternal miscarriage, or induced abortion were excluded. immunologic response to the pregnancy, which also is thought We determined the first date of the last menstrual cycle to be involved in placentation [5, 6, 14]. Maternal immune from the BIDMC delivery information by subtracting the ges- tolerance is necessary in any pregnancy, given a woman typ- tational age at delivery from the date of delivery. Gestational ically shares only half of the genetic material with the fetus age at delivery is recorded by a clinician based on the best [21]. Women who undergo IVF with donor oocytes do not available data in the medical record (first day of the last men- share any genetic material with the fetus, potentially decreas- strual period, early ultrasound measures, or IVF dating, as ing the immune tolerance needed for an uncomplicated preg- appropriate). To allow for error in gestational age and differ- nancy [6 , 14, 21]. This decreased maternal tolerance to the ences in the length of an IVF cycle, while not capturing a fetus may lead to a higher risk of abnormal placentation and second pregnancy after a potentially failed IVF cycle, we cre- result in obstetric and neonatal complications [5, 6, 21]. ated a 56-day window around last menstrual period (28 days Based on prior work, we hypothesized that the risk of IPD prior to the last menstrual period and 28 days after the last would be elevated among pregnancies conceived with donor menstrual period). We then used the IVF cycle start date from oocytes “donor IVF” and a woman’s own oocytes “autolo- the Boston IVF data to identify matches where the cycle start gous IVF” compared with non-IVF pregnancies. Given the date fell within that window and the maternal date of birth and potential immune response to donor oocytes, we also hypoth- last name were identical. Due to concerns about spelling dif- esized there would be an even higher risk of IPD for donor ferences of the name, a second match was done on the remain- IVF pregnancies compared with autologous IVF pregnancies. ing cycles without including name, and all matches were To assess these hypotheses, we evaluated the risk of IPD confirmed. among donor and autologous IVF pregnancies compared with The maternal name, date of birth, and date of BIDMC non-IVF pregnancies, as well as the risk of IPD in donor deliveries were sent to the Massachusetts Department of compared with autologous IVF pregnancies. Public Health and matched to birth certificate data. J Assist Reprod Genet (2019) 36:1917–1926 1919 Pregnancies identified on the birth certificate by maternal re- cases and 89.7% of the potential abruption cases. port as the result of IVF treatment were included in one of the Pregnancies after July 1, 2008, where the diagnosis could IVF exposure groups. This would capture IVF pregnancies at not be verified, were considered to not have the condition. other institutions/clinics. Pregnancies not identified as a result Given the high accuracy of the ICD9 codes in the later time of donor IVF were considered to be from autologous IVF. period, any pregnancy with ICD9 codes for preeclampsia or Deliveries that were not identified as resulting from IVF by placental abruption prior to July 1, 2008 was considered to the Boston IVF data or birth certificate data were considered have the complication.
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