Abstract
The aim of this study was to explore if fetal and maternal outcomes, in particular the incidence of PIH and the incidence of SGA infants, are different in pregnancies achieved with ED or pregnancies achieved by in vitro fertilisation with autologous oocytes (IVF). This is a prospective study during a three-year period. We included 320 pregnancies; 68 (21,3%) achieved with ED, 82 (25,6%) with IVF and 170 (53,1%) spontaneous (S). Women with uterine malformations, chronic hypertension, autoimmune diseases, pregnancy with fetal structural abnormalities, aneuploidy or multiple gestations were excluded. Since ED are obtained by intra-cytoplasmatic sperm injection (ICSI), we included only ICSI procedures. For each ED pregnancy, except for the patients aged >45 years, the first two subsequent pregnancies obtained with the couples' gametes were retained as controls, with matching for mother's age and parity. No statistically significant difference was found in demographic characteristics (age, body mass index and parity), although only in ED group patients conceived after 45 years. Patients with ED compared with those with IVF pregnancies had significantly higher mean uterine artery pulsatility index (UtA PI) in the 1st (1.87 vs 1.67, p=0.029) and 2nd (1.51 vs 0.91, p<0.001) trimester of pregnancy, and higher incidence of SGA (25% vs 13.4%, p<0.001) and PIH (25% vs 12.2%, p=0.042). Logistic regression analysis demonstrated that maternal age (OR=0.89 CI 95% 0.841-0.956; p<0.001) and ED (OR=7,233 CI 95% 2.862-20.666; p<0.001) were the two only independent risk factors for PIH; while ED was the only independent risk factor for SGA (OR=3.61 CI 95% 1,457-8.957; p=0.006) when adjusted with other confounder variables. Pregnancies achieved with ED are at increased risk of PIH, even at young age and the risk of delivering a SGA infant is three time higher compared to IVF and spontaneous pregnancies.
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