Increased risk of pregnancy induced hypertension and operative delivery after conception induced by in vitro fertilization intracytoplasmic sperm injection in women aged 40 years and older

Capsule:
Preconception fertility status affects the incidence of pregnancy-induced hypertension and delivery outcomes in women aged 40 years and older.

Authors:
Masatake Toshimitsu, M.D., Takeshi Nagamatsu, M.D., Ph.D., Takaaki Nagasaka, M.D., Yuki Iwasawa-Kawai, M.D., Ph.D., Atsushi Komatsu, M.D., Ph.D., Takahiro Yamashita, M.D., Ph.D., Yutaka Osuga, M.D., Ph.D., Tomoyuki Fujii, M.D., Ph.D.

Volume 102, Issue 4, Pages 1065-1070

Abstract:

Objective:
To clarify the association between preconception fertility status and obstetric outcomes in women aged 40 years and older.

Design:
Retrospective study by reviewing medical records.

Setting:
Tertiary perinatal center in a university hospital.

Patient(s):
330 women aged 40 years and older who delivered a singleton from 2006 to 2010, and 450 women aged 30 to 34 years who delivered at the same facility as controls.

Intervention(s):
None.

Main Outcome Measure(s):
Incidence of pregnancy-induced hypertension, gestational diabetes mellitus, preterm birth, low birth weight, and mode of delivery assessed based on the mode of conception; spontaneous conception (SC) and in vitro fertilization/intracytoplasmic sperm injection conception (IVF-ICSI).

Result(s):
The incidence of pregnancy-induced hypertension was statistically significantly higher in IVF-ICSI group than the SC group. This gap was commonly observed in both the women aged 40 years and older and those in the 30 to 34 age group. No statistically significant difference was observed in the frequency of gestational diabetes mellitus, preterm birth, or low birth weight. As a characteristic of nulliparous women of advanced age, the rate of operative delivery, which includes emergency cesarean section and instrumental delivery, was statistically significantly higher in IVF-ICSI group than in the SC group. Detailed investigation into the medical indications for operative delivery revealed that the difference was attributable to the elevated incidence of labor protraction and arrest.

Conclusion(s):
Preconception fertility status can be a predicting factor of the incidence of pregnancy-induced hypertension and labor outcome, especially for women aged 40 years and older.

  • Reshef Tal

    This is an interesting study that corroborates the evidence suggesting that IVF/ICSI is
    associated with increased rates of hypertensive disorders of pregnancy. I liked
    the stratification by age which accentuates these differences even further. I
    had one question for the authors. In their study, in both age groups, nulliparity
    was much more common in IVF/ICSI group vs. spontaneous conception group (79.5-89.3% vs. 45.9-59.7%, respectively). Since nulliparity is known to be an independent risk factor for preeclampsia, did the authors control for this?

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