< Terug naar vorige pagina
Publicatie
Oocyte donation is a risk factor for first trimester bleeding and pregnancy induced hypertension but without efffect on the perinatal outcome
Tijdschriftbijdrage - Tijdschriftartikel Conferentiebijdrage
Introduction:
Oocyte donation (OD) has become well established. As with any other reproductive techniques, assessment of possible associated obstetric and perinatal risk remains paramount. To evaluate the pure obstetrical and perinatal impact of conceiving through OD we compared an OD-group with a matched control group of autologeous oocytes (AO). Secondly, we evaluate differences in obstetrical and perinatal outcome between OD-pregnancies for which an appropriate AO-match was available, versus OD-pregnancies at an advanced maternal age and therefore without a match.
Materials and Methods:
All singleton (n = 210) and twin (n = 87) pregnancies beyond 20 weeks of gestation conceived after OD at our centre between 1999 and 2008 were considered for this study. Controls were selected from the patient population undergoing in-vitro fertilization with AO. As for the OD-pregnancies, all controls were conceived with the intra cytoplasmic sperm injection (ICSI) technique. A match for maternal age ( ± 12 months), parity, plurality (singleton or twin) and gender of the children could be found for 205 OD-pregnancies resulting in 262 live births. Obstetrical outcome data from these 205 OD-pregnancies and their matched control pregnancies were analysed by multivariate analysis. Matched groups were compared using paired t tests for continuous variables and McNemar test for categorical variables. We performed conditional logistic regression analyses, further adjusting for paternal age, age of the oocyte donor and for the number of embryos transferred on the obstetric and perinatal outcomes. Obstetrical and perinatal outcome of OD-pregnancies without available match were analysed using Student t tests for continuous variables and Fisher's exact test for categorical variables. We also conducted linear and binary logistic regression analyses adjusting for baseline characteristics of interest.
Results:
OD is associated with a increased risk of first trimester bleeding (OR:1.493 CI:1.036-2.15) and pregnancy induced hypertension (PIH) (OR:1.502 CI: 1.024-2.204) as seen by conditional logistic regression of the matched groups after further adjusting for paternal age, age of the donor and number of transferred embryos. No differences in gestational age, mean birth weight and length, head circumference or Apgar scores were observed between the two matched groups.
Logistic regression of obstetrical outcome parameters in all OD-pregnancies (n = 297) found a significant relation between preterm labour, the incidence of caesarean section and the presence of a twin pregnancy.
Matching could not be performed for 152 live births resulting from 92 singleton pregnancies and 30 twin OD-pregnancies. These oocyte recipients without an available AO-match in our ICSI-population were significantly (p <0.001) older and had a higher parity in both singletons (36.27 vs. 46.28 and 0.23 vs. 0.48) as in twin (36.59 vs. 45.47 and 0.22 vs. 0.77) OD-pregnancies. A higher incidence of preterm births were observed in singletons (15.3% vs. 37.5%; p = 0.01) but not in the twin (82.5% vs 89.5%; p = 0.46) OD-pregnancies. Singleton pregnancies in the older OD-population had a lower average gestational age (272.35 vs 262.81 days (p = 0.043)) and a lower average birth weight (3211.86 vs. 3027.35 g (p = 0.008)) and length (49.69 vs. 47.71 cm (p = 0.003). These differences were not observed in twin pregnancies. Neither was there any difference in the incidence of low (<2500g) and very low (>1500g) birth weight babies between the older and younger OD-population in singletons and twin pregnancies.
Conclusion:
This is the first large follow-up study that demonstrates that OD is associated with an increased risk for first trimester bleeding and PIH independent of the recipients' parity, plurality or age of the recipient, donor or partner. However, no difference in perinatal outcome is observed after OD. A shorter gestational age and a lower birth weight and length were observed in OD-recipients of an advanced maternal age as compared to OD-recipients at an age were ICSI-pregnancies with AO available.
Oocyte donation (OD) has become well established. As with any other reproductive techniques, assessment of possible associated obstetric and perinatal risk remains paramount. To evaluate the pure obstetrical and perinatal impact of conceiving through OD we compared an OD-group with a matched control group of autologeous oocytes (AO). Secondly, we evaluate differences in obstetrical and perinatal outcome between OD-pregnancies for which an appropriate AO-match was available, versus OD-pregnancies at an advanced maternal age and therefore without a match.
Materials and Methods:
All singleton (n = 210) and twin (n = 87) pregnancies beyond 20 weeks of gestation conceived after OD at our centre between 1999 and 2008 were considered for this study. Controls were selected from the patient population undergoing in-vitro fertilization with AO. As for the OD-pregnancies, all controls were conceived with the intra cytoplasmic sperm injection (ICSI) technique. A match for maternal age ( ± 12 months), parity, plurality (singleton or twin) and gender of the children could be found for 205 OD-pregnancies resulting in 262 live births. Obstetrical outcome data from these 205 OD-pregnancies and their matched control pregnancies were analysed by multivariate analysis. Matched groups were compared using paired t tests for continuous variables and McNemar test for categorical variables. We performed conditional logistic regression analyses, further adjusting for paternal age, age of the oocyte donor and for the number of embryos transferred on the obstetric and perinatal outcomes. Obstetrical and perinatal outcome of OD-pregnancies without available match were analysed using Student t tests for continuous variables and Fisher's exact test for categorical variables. We also conducted linear and binary logistic regression analyses adjusting for baseline characteristics of interest.
Results:
OD is associated with a increased risk of first trimester bleeding (OR:1.493 CI:1.036-2.15) and pregnancy induced hypertension (PIH) (OR:1.502 CI: 1.024-2.204) as seen by conditional logistic regression of the matched groups after further adjusting for paternal age, age of the donor and number of transferred embryos. No differences in gestational age, mean birth weight and length, head circumference or Apgar scores were observed between the two matched groups.
Logistic regression of obstetrical outcome parameters in all OD-pregnancies (n = 297) found a significant relation between preterm labour, the incidence of caesarean section and the presence of a twin pregnancy.
Matching could not be performed for 152 live births resulting from 92 singleton pregnancies and 30 twin OD-pregnancies. These oocyte recipients without an available AO-match in our ICSI-population were significantly (p <0.001) older and had a higher parity in both singletons (36.27 vs. 46.28 and 0.23 vs. 0.48) as in twin (36.59 vs. 45.47 and 0.22 vs. 0.77) OD-pregnancies. A higher incidence of preterm births were observed in singletons (15.3% vs. 37.5%; p = 0.01) but not in the twin (82.5% vs 89.5%; p = 0.46) OD-pregnancies. Singleton pregnancies in the older OD-population had a lower average gestational age (272.35 vs 262.81 days (p = 0.043)) and a lower average birth weight (3211.86 vs. 3027.35 g (p = 0.008)) and length (49.69 vs. 47.71 cm (p = 0.003). These differences were not observed in twin pregnancies. Neither was there any difference in the incidence of low (<2500g) and very low (>1500g) birth weight babies between the older and younger OD-population in singletons and twin pregnancies.
Conclusion:
This is the first large follow-up study that demonstrates that OD is associated with an increased risk for first trimester bleeding and PIH independent of the recipients' parity, plurality or age of the recipient, donor or partner. However, no difference in perinatal outcome is observed after OD. A shorter gestational age and a lower birth weight and length were observed in OD-recipients of an advanced maternal age as compared to OD-recipients at an age were ICSI-pregnancies with AO available.
Tijdschrift: Hum Reprod
ISSN: 0268-1161
Volume: 25
Pagina's: 237-238
Jaar van publicatie:2010
Trefwoorden:oocyte donation, pregnancy