Assisted reproductive technologies (ART) may be associated with placental abnormalities including placenta previa, umbilical cord abnormalities, and placental abruption. Our study evaluates the relationship between ART and placental abnormalities compared with spontaneously conceived controls.
An IRB-approved cohort study was conducted including women who delivered between January 2013 and December 2018. We excluded delivery prior to 23 weeks and known fetal anomalies. Patients were matched with controls (2:1) for parity, age, and mode of delivery. Controls were women who had spontaneously conceived and delivered immediately preceding and following the index delivery. The primary outcome was placental abnormalities found on both antenatal ultrasound and pathology in ART gestations compared with spontaneously conceived gestations.
There were 120 ART pregnancies and 240 matched control pregnancies identified. The groups were similar for parity, BMI, comorbidities, number of multiples, mode of delivery, and female newborns. The ART group had a higher maternal age (37.1±5 y vs. 30.0±5 y; p<0.001), greater preterm birth (29 vs. 6%; p<0.001), and lower BW (2,928±803 g vs. 3,273±586 g; p<0.001). The ART group had a higher incidence of placenta previa on ultrasound (4.0 vs. 0.4%, p=0.01), adherent placentas at delivery (3 vs. 0% p=0.014), placental abruption (2 vs. 0%; p=0.04), as well as an increased rate of velamentous cord insertion (12 vs. 3%, p<0.001) and marginal cord insertion (28 vs. 15%, p=0.002). ART demonstrated a two-fold likelihood of abnormal placental pathology.
ART is associated with increased rate of placental abnormalities, including abnormal umbilical cord insertion and increased rates of adherent placentation. This information may be beneficial in planning and surveillance in patients with ART pregnancies.
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The study was approved by the Institutional Review Board.
1. Centers for Disease Control and Prevention. ART fertility clinic success rates report; 2017. Available from: https://www.cdc.gov/art/reports/2016/national-summary.html.Search in Google Scholar
2. Dyer, S, Chambers, G, De Mouzon, J, Nygren, K, Zegers-Hochschild, F, Mansour, R, et al. International committee for monitoring assisted reproductive technologies world report: assisted reproductive technology 2008, 2009 and 2010. Hum Reprod 2016;31:1588–609. https://doi.org/10.1093/humrep/dew082.Search in Google Scholar
3. Romundstad, LB, Romundstad, PR, Sunde, A, von During, V, Skjaerven, R, Vatten, LJ. Increased risk of placenta previa in pregnancies following IVF/ICSI; a comparison of ART and non-ART pregnancies in the same mother. Hum Reprod 2006;21:2353–8. https://doi.org/10.1093/humrep/del153.Search in Google Scholar
4. Luke, B, Gopal, D, Cabral, H, Stem, JE, Diop, H. Pregnancy, birth, and infant outcomes by maternal fertility status: the Massachusetts Outcomes Study of Assisted Reproductive Technology. Am J Obstet Gynecol 2017;217:327. e1–e14. https://doi.org/10.1016/j.ajog.2017.04.006.Search in Google Scholar
5. Qin, J, Liu, X, Sheng, X, Wang, H, Gao, S. Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a metaanalysis of cohort studies. Fertil Steril 2016;105:73–85. e6. https://doi.org/10.1016/j.fertnstert.2015.09.007.Search in Google Scholar
6. Ombelet, W, Martens, G, Bruckers, L. Pregnant after assisted reproduction: a risk pregnancy is born! 18-years perinatal outcome results from a population-based registry in Flanders, Belgium. Facts Views Vis Ob Gyn 2016;8:193.Search in Google Scholar
7. Wang, YA, Chughtai, AA, Farquhar, CM, Pollock, W, Lui, K, Sullivan, EA. Increased incidence of gestational hypertension and preeclampsia after assisted reproductive technology treatment. Fertil Steril 2016;105:920–6.e2. https://doi.org/10.1016/j.fertnstert.2015.12.024.Search in Google Scholar
8. Kelley, BP, Klochko, CL, Atkinson, S, Hillman, D, Craig, BM, Sandberg, SA, et al. Sonographic diagnosis of velamentous and marginal placental cord insertion. Ultrasound Quart 2019; Mar 11. https://doi.org/10.1097/ruq.0000000000000437 [Epub ahead of print].Search in Google Scholar
9. Zhu, L, Zhang, Y, Liu, Y, Zhang, R, Wu, Y, Huang, Y, et al. Maternal and live-birth outcomes of pregnancies following assisted reproductive technology: a retrospective cohort study. Sci Rep 2016;6:35141. https://doi.org/10.1038/srep35141.Search in Google Scholar
10. Suzuki, S, Kato, M. Clinical significance of pregnancies complicated by velamentous umbilical cord insertion associated with other umbilical cord/placental abnormalities. J Clin Med Res 2015;7:853–6. https://doi.org/10.14740/jocmr2310w.Search in Google Scholar
11. Luke, B. Pregnancy and birth outcomes in couples with infertility with and without assisted reproductive technology: with an emphasis on US population-based studies. Am J Obstet Gynecol 2017;217:270–81. https://doi.org/10.1016/j.ajog.2017.03.012.Search in Google Scholar
12. Baldwin, H, Patterson, J, Nippita, T, Torvaldsen, S, Ibiebele, I, Simpson, J, et al. Antecedents of abnormally invasive placenta in primiparous women risk associated with gynecologic procedures. Am J Obstet Gynecol 2018;131:227–33. https://doi.org/10.1097/aog.0000000000002434.Search in Google Scholar
13. Vitagliano, A, Andrisani, A, Alviggi, C, Vitale, SG, Valenti, G, Sapia, F, et al. Endometrial scratching for infertile women undergoing a first embryo transfer: a systematic review and meta-analysis of published and unpublished data from randomized controlled trials. Fertil Steril 2019;111:734–46. https://doi.org/10.1016/j.fertnstert.2018.12.008.Search in Google Scholar
14. Bar, G, Harlev, A, Alfayumi-Zeadna, S, Zeadna, A, Bord, I, Har-Vardi, I, et al. Recurrent implantation failure: which patients benefit from endometrial scratching prior to IVF?. Arch Gynecol Obstet 2020;301:817–22. https://doi.org/10.1007/s00404-019-05424-1.Search in Google Scholar
15. Miller, D, Chollet, J, Goodwin, T. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997;177:210–14. https://doi.org/10.1016/s0002-9378(97)70463-0.Search in Google Scholar
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