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Obstetric and perinatal outcomes of singleton pregnancies conceived via assisted reproductive technology complicated by gestational diabetes mellitus: a prospective cohort study.
BMC Pregnancy Childbirth. 2018 Dec 14; 18(1):495.BP

Abstract

BACKGROUND

Growing evidence indicates that the risk of obstetric and perinatal outcomes is higher in women with assisted reproductive technology (ART). However, there is little known about pregnancy related complications and co-morbidity in gestational diabetes mellitus (GDM) following singleton pregnancies achieved by ART in comparison with spontaneous conception (SC).

METHODS

Two hundred sixty singleton pregnant women conceived by ART and 314 pregnant women conceived by spontaneous conception (SC) were participated in this prospective cohort study. All participants were enrolled after GDM screening through one-step oral glucose tolerance test (OGTT) and then grouped into GDM and non-GDM groups. Women were followed for pregnancy outcomes including pregnancy-induced hypertension (PIH), preeclampsia, antepartum hemorrhage (APH), cesarean section (CS), preterm birth (PTB), intrauterine growth restriction (IUGR), being small or large for gestational age (SGA or LGA), macrosomia, low birth weight (LBW), respiratory distress, neonatal hypoglycemia, NICU admission and perinatal mortality from antenatal visits to delivery. Confounding factors were adjusted in logistic regression model in order to estimate adjusted odds ratios (aORs).

RESULTS

Among 260 ART and 314 SC, 135 and 152 women were GDM women, respectively. Higher maternal age and pre-gravid BMI, shorter duration of gestation and lower gestational weight gain were observed in GDM groups (ART-GDM and SC-GDM) compared to those of the SC group. ART-GDM group had a higher risk (95% confidence interval) of obstetric complications including PIH [aOR:7.04 (2.24-22.15)], preeclampsia [aOR:7.78 (1.62-37.47)], APH [aOR:3.46 (1.28-9.33)], emergency CS [aOR:2.64 (1.43-4.88)], and perinatal outcomes such as PTB [aOR:3.89 (1.51-10.10)], LBW [aOR:3.11 (1.04-9.30)] and NICU admission [aOR:4.36 (1.82-10.45)], as well as neonatal hypoglycemia [aOR: 4.91 (1.50-16.07)], compared to SC group. SC-GDM group showed a higher risk of PIH [aOR: 4.12 (1.31-12.89)], emergency CS [aOR: 2.01 (1.09-3.73] and LGA [aOR: 5.20 (1.07-25.20)], compared to SC group. Additionally, ART group had a higher risk of PIH [aOR: 3.46(1.02-11.68), preeclampsia 5.29 (1.03-27.09), and NICU admission [aOR: 2.53 (1.05-6.09)] compared to SC. Insulin requirement (41.8% vs. 25.7%) was significantly higher in ART-GDM group compared to SC-GDM group.

CONCLUSION

The findings of this study suggest that GDM occurring after ART conception increases the risk of adverse obstetric and perinatal outcomes.

Authors+Show Affiliations

Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Firouzeh St., South Vali- Asr Ave., Vali- Asr Sq., Tehran, 15937-16615, Iran. Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Number 12, East Hafez Avenue, Bani Hashem Street, Resalat Highway, Tehran, 16635-148, Iran.Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Firouzeh St., South Vali- Asr Ave., Vali- Asr Sq., Tehran, 15937-16615, Iran.Department of Gynecology and Obstetrics, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Number 12, East Hafez Avenue, Bani Hashem Street, Resalat Highway, Tehran, 16635-148, Iran. Department of Gynecology and Obstetrics, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Number 12, East Hafez Avenue, Bani Hashem Street, Resalat Highway, Tehran, 16635-148, Iran.Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Number 12, East Hafez Avenue, Bani Hashem Street, Resalat Highway, Tehran, 16635-148, Iran. rohosseini@yahoo.com. Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. rohosseini@yahoo.com.Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Firouzeh St., South Vali- Asr Ave., Vali- Asr Sq., Tehran, 15937-16615, Iran. baradaran.hr@iums.ac.ir. Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, AB25 2ZD, UK. baradaran.hr@iums.ac.ir.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30547777

Citation

Kouhkan, Azam, et al. "Obstetric and Perinatal Outcomes of Singleton Pregnancies Conceived Via Assisted Reproductive Technology Complicated By Gestational Diabetes Mellitus: a Prospective Cohort Study." BMC Pregnancy and Childbirth, vol. 18, no. 1, 2018, p. 495.
Kouhkan A, Khamseh ME, Pirjani R, et al. Obstetric and perinatal outcomes of singleton pregnancies conceived via assisted reproductive technology complicated by gestational diabetes mellitus: a prospective cohort study. BMC Pregnancy Childbirth. 2018;18(1):495.
Kouhkan, A., Khamseh, M. E., Pirjani, R., Moini, A., Arabipoor, A., Maroufizadeh, S., Hosseini, R., & Baradaran, H. R. (2018). Obstetric and perinatal outcomes of singleton pregnancies conceived via assisted reproductive technology complicated by gestational diabetes mellitus: a prospective cohort study. BMC Pregnancy and Childbirth, 18(1), 495. https://doi.org/10.1186/s12884-018-2115-4
Kouhkan A, et al. Obstetric and Perinatal Outcomes of Singleton Pregnancies Conceived Via Assisted Reproductive Technology Complicated By Gestational Diabetes Mellitus: a Prospective Cohort Study. BMC Pregnancy Childbirth. 2018 Dec 14;18(1):495. PubMed PMID: 30547777.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Obstetric and perinatal outcomes of singleton pregnancies conceived via assisted reproductive technology complicated by gestational diabetes mellitus: a prospective cohort study. AU - Kouhkan,Azam, AU - Khamseh,Mohammad E, AU - Pirjani,Reihaneh, AU - Moini,Ashraf, AU - Arabipoor,Arezoo, AU - Maroufizadeh,Saman, AU - Hosseini,Roya, AU - Baradaran,Hamid Reza, Y1 - 2018/12/14/ PY - 2018/07/29/received PY - 2018/11/22/accepted PY - 2018/12/15/entrez PY - 2018/12/15/pubmed PY - 2019/4/6/medline KW - Assisted reproductive technology KW - Complications KW - Gestational diabetes mellitus KW - Neonatal KW - Obstetric KW - Perinatal SP - 495 EP - 495 JF - BMC pregnancy and childbirth JO - BMC Pregnancy Childbirth VL - 18 IS - 1 N2 - BACKGROUND: Growing evidence indicates that the risk of obstetric and perinatal outcomes is higher in women with assisted reproductive technology (ART). However, there is little known about pregnancy related complications and co-morbidity in gestational diabetes mellitus (GDM) following singleton pregnancies achieved by ART in comparison with spontaneous conception (SC). METHODS: Two hundred sixty singleton pregnant women conceived by ART and 314 pregnant women conceived by spontaneous conception (SC) were participated in this prospective cohort study. All participants were enrolled after GDM screening through one-step oral glucose tolerance test (OGTT) and then grouped into GDM and non-GDM groups. Women were followed for pregnancy outcomes including pregnancy-induced hypertension (PIH), preeclampsia, antepartum hemorrhage (APH), cesarean section (CS), preterm birth (PTB), intrauterine growth restriction (IUGR), being small or large for gestational age (SGA or LGA), macrosomia, low birth weight (LBW), respiratory distress, neonatal hypoglycemia, NICU admission and perinatal mortality from antenatal visits to delivery. Confounding factors were adjusted in logistic regression model in order to estimate adjusted odds ratios (aORs). RESULTS: Among 260 ART and 314 SC, 135 and 152 women were GDM women, respectively. Higher maternal age and pre-gravid BMI, shorter duration of gestation and lower gestational weight gain were observed in GDM groups (ART-GDM and SC-GDM) compared to those of the SC group. ART-GDM group had a higher risk (95% confidence interval) of obstetric complications including PIH [aOR:7.04 (2.24-22.15)], preeclampsia [aOR:7.78 (1.62-37.47)], APH [aOR:3.46 (1.28-9.33)], emergency CS [aOR:2.64 (1.43-4.88)], and perinatal outcomes such as PTB [aOR:3.89 (1.51-10.10)], LBW [aOR:3.11 (1.04-9.30)] and NICU admission [aOR:4.36 (1.82-10.45)], as well as neonatal hypoglycemia [aOR: 4.91 (1.50-16.07)], compared to SC group. SC-GDM group showed a higher risk of PIH [aOR: 4.12 (1.31-12.89)], emergency CS [aOR: 2.01 (1.09-3.73] and LGA [aOR: 5.20 (1.07-25.20)], compared to SC group. Additionally, ART group had a higher risk of PIH [aOR: 3.46(1.02-11.68), preeclampsia 5.29 (1.03-27.09), and NICU admission [aOR: 2.53 (1.05-6.09)] compared to SC. Insulin requirement (41.8% vs. 25.7%) was significantly higher in ART-GDM group compared to SC-GDM group. CONCLUSION: The findings of this study suggest that GDM occurring after ART conception increases the risk of adverse obstetric and perinatal outcomes. SN - 1471-2393 UR - https://www.unboundmedicine.com/medline/citation/30547777/Obstetric_and_perinatal_outcomes_of_singleton_pregnancies_conceived_via_assisted_reproductive_technology_complicated_by_gestational_diabetes_mellitus:_a_prospective_cohort_study_ L2 - https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-2115-4 DB - PRIME DP - Unbound Medicine ER -