Analysis Of Preeclampsia Associated With In Vitro Fertilization

ObjectiveWe aimed to estimate the risk of preeclampsia(PE)associated with in vitro fertilization(IVF),to evaluated possible impact of IVF on the disease progression and prognosis of PE,and to identify potential predisposing factors responsible for the observed association.Methods1.This retrospective cohort study included 114485 women who delivered at the Nanjing Maternity and Child Health Care Hospital between October 2013 and October2018.Of the 114485 women,4601(4%)conceived through IVF(IVF group)and109884(96%)conceived spontaneously(SC group).We evaluated the demographic characteristics and pregnancy outcomes of IVF patients,and compared the prevalence of PE between IVF and SC group.2.Based on the data from March 2016 to October 2018,we performed logistic regression analysis to estimate the risk of PE following IVF compared to spontaneous conception(SC),together with the impact of other risk factors on PE.3.Based on data from October 2013 to October 2018,we performed two sub-analyses using stratification and strict criteria for participants.In the first sub-analysis restricted to preeclamptic pregnancies,we compared the disease course,phenotype and pregnancy outcomes of PE between IVF and spontaneously conceived patients.4.In the second sub-analysis limited to IVF pregnancies,we performed propensity score matching(PSM)analysis to compare clinical characteristics and pregnancy outcomes between preeclamptic and normotensive patients.Results1.There were 1339 PE cases in the total study population,with a significantly higher incidence of PE in IVF relative to spontaneous pregnancies(6.1% vs.1.0%,p<0.01).2.The study limited to data from March 2016 to October 2018 enrolled 2353 IVF patients and 43919 spontaneously conceived women,of whom 157 and 404 women were diagnosed with PE,respectively.IVF mothers had a 1.6-fold increased likelihood of presenting with PE(a OR 2.60,95% CI 1.98-3.42,p<0.01)compared to SC mothers.3.The sub-analysis within preeclamptic pregnancies included 86 IVF patients(IVFPE group)and 630 spontaneously conceived women(SC-PE group).Severe PE was more prevalent in singleton IVF-PE group than in singleton SC-PE group(40% vs.24.1%,p=0.025).Higher incidences of gestational diabetes mellitus,hypothyroidism,and placenta accreta were observed in singleton IVF-PE group compared to singleton SC-PE group(27.5% vs.14.6%,p=0.029;35.9% vs.20.1%,p=0.019;12.5% vs.2.6%,p=0.003;respectively).Postpartum haemorrhage was more common in twin IVF-PE group in contrast with twin SC-PE group(47.8 vs.23.8%,p=0.019).The rate of caesarean section was higher in singleton IVF-PE group relative to singleton SC-PE group(85% vs.65.3%,P=0.011).4.The sub-analysis within IVF pregnancies enrolled 87 preeclamptic patients(IVFPE group)and 87 normotensive mothers(IVF-normotensive group).38 paired singleton mothers and 49 paired twin mothers(both with one mother from the preeclamptic group and one from the normotensive group)were identified by PSM procedure.The IVF-PE group showed more frequent first-trimester bleeding(31.6%vs.10.5%,p=0.024)compared to the control group.Pathological diagnosis of placental hypoxia was more common in twin IVF-PE group than in twin IVF-normotensive group(12% vs.0%,p=0.045).Conclusions1.IVF is accompanied by an increased risk of PE.2.IVF is implicated in the progression of PE,including disease exacerbation and increased comorbidities.3.Defective placentation and placental insufficiency may predispose IVF patients to PE and may manifest as first-trimester bleeding.