Bjorn Bay1, Hans Jakob Ingerslev2, Josephine Gabriela Lemmen3, Birte Degn2, Iben Anne Rasmussen4, Ulrik Schiøler Kesmodel5. 1. The Fertility Clinic and Center of Preimplantation Genetic Diagnosis, Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; The Fertility Clinic, Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Aarhus University, Regionshospitalet, Horsens, Denmark. Electronic address: bjornbay@me.com. 2. The Fertility Clinic and Center of Preimplantation Genetic Diagnosis, Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark. 3. The Fertility Clinic, Rigshospitalet, Copenhagen, Denmark. 4. The Fertility Clinic, Department of Gynecology and Obstetrics, Odense Universitetshospital, Odense, Denmark. 5. The Fertility Clinic and Center of Preimplantation Genetic Diagnosis, Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; The Fertility Clinic, Department of Gynecology and Obstetrics, Herlev and Gentofte Hospital, Herlev, Denmark.
Abstract
OBJECTIVE: To study whether women conceiving after preimplantation genetic diagnosis (PGD) and their children have greater risks of adverse pregnancy and birth outcomes compared with children conceived spontaneously or after IVF with or without intracytoplasmic sperm injection (ICSI). DESIGN: Historical cohort study. SETTING: Not applicable. PATIENT(S): All deliveries following PGD treatment for single gene and sex-linked disorders or structural chromosomal aberrations (n = 126 deliveries/149 children), IVF/ICSI treatment (n = 30,418 deliveries/36,115 children), and spontaneous conception (n = 896,448 deliveries/909,624 children). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Adverse obstetric and neonatal outcomes, such as pre-eclampsia, preterm primary rupture of membranes, placenta previa, abruption of placenta, preterm birth, low birth weight, malformations, and neonatal admission. RESULT(S): Compared with spontaneously conceived pregnancies, PGD pregnancies were at significantly increased risk of placenta previa (adjusted odds ratio [ORa] 9.1; 95% confidence interval [95% CI] 3.4, 24.9), cesarean section (ORa 2.0; 95% CI 1.3, 2.9), preterm birth (ORa 1.6; 95% CI 1.0, 2.7), shorter gestation (mean difference -3.4 days; 95% CI -5.7, -1.1 days), and longer neonatal admission (mean difference 21 days; 95% CI 15, 28 days). The risks were comparable to that of pregnancies following IVF/ICSI. In subanalyses, adverse outcomes were only present in children conceived by PGD owing to parental monogenetic disorder and comparable to those of children born to parents with monogenic disorders conceiving without PGD, except for a higher risk of placenta previa. CONCLUSION(S): In this cohort study, the risk of adverse obstetric and neonatal outcomes was mainly related to the underlying parental condition rather than the PGD procedure.
OBJECTIVE: To study whether women conceiving after preimplantation genetic diagnosis (PGD) and their children have greater risks of adverse pregnancy and birth outcomes compared with children conceived spontaneously or after IVF with or without intracytoplasmic sperm injection (ICSI). DESIGN: Historical cohort study. SETTING: Not applicable. PATIENT(S): All deliveries following PGD treatment for single gene and sex-linked disorders or structural chromosomal aberrations (n = 126 deliveries/149 children), IVF/ICSI treatment (n = 30,418 deliveries/36,115 children), and spontaneous conception (n = 896,448 deliveries/909,624 children). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Adverse obstetric and neonatal outcomes, such as pre-eclampsia, preterm primary rupture of membranes, placenta previa, abruption of placenta, preterm birth, low birth weight, malformations, and neonatal admission. RESULT(S): Compared with spontaneously conceived pregnancies, PGD pregnancies were at significantly increased risk of placenta previa (adjusted odds ratio [ORa] 9.1; 95% confidence interval [95% CI] 3.4, 24.9), cesarean section (ORa 2.0; 95% CI 1.3, 2.9), preterm birth (ORa 1.6; 95% CI 1.0, 2.7), shorter gestation (mean difference -3.4 days; 95% CI -5.7, -1.1 days), and longer neonatal admission (mean difference 21 days; 95% CI 15, 28 days). The risks were comparable to that of pregnancies following IVF/ICSI. In subanalyses, adverse outcomes were only present in children conceived by PGD owing to parental monogenetic disorder and comparable to those of children born to parents with monogenic disorders conceiving without PGD, except for a higher risk of placenta previa. CONCLUSION(S): In this cohort study, the risk of adverse obstetric and neonatal outcomes was mainly related to the underlying parental condition rather than the PGD procedure.
Authors: Michael S Awadalla; Kristen E Park; Kyle R Latack; Lynda K McGinnis; Ali Ahmady; Richard J Paulson Journal: Reprod Sci Date: 2021-03-25 Impact factor: 3.060
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