P–762 Preeclampsia in pregnancies resulting from oocyte donation, IVF or natural conception. A systematic review and meta-analysis

Abstract

Abstract Study question What is the prevalence of preeclampsia (PE) in pregnancies after oocyte donation (OD) compared to natural conception (NC) and to IVF with autologous oocytes? Summary answer PE prevalence in singleton pregnancies after OD was five times higher than in NC and almost three times higher than after IVF with autologous oocytes. What is known already: The indication for OD is expanding to lesbian women requesting shared lesbian motherhood. Previous reviews showed that the risk of PE is higher in pregnancies after OD than after IVF with autologous oocytes and natural conception. Classification on severity of PE is lacking as is the relationship with known risk factors such as maternal age and multiple gestations. Furthermore the actual prevalence of PE following in pregnancies resulting from OD is not known. Study design, size, duration Systematic review and meta-analysis. A literature search was performed using the following databases: PubMed, EMBASE and CINAHL, OpenGrey and Greynet from January 1980 through July 2020. Participants/materials, setting, methods We included retrospective and prospective cohort studies. The study population consisted of pregnancies after OD and NC or IVF and data had to be available about prevalence of PE. We compared the risk of (severe) PE in OD versus NC and IVF pregnancies, subgrouped by parity and maternal age. We calculated individual and pooled odds ratios (OR) and prevalence estimates with 95% CI using a random effect model, while heterogeneity was assessed by the I2. Main results and the role of chance We included 28 studies comprising of 7131 OD pregnancies, 1.139.540 NC pregnancies and 72.763 IVF pregnancies were available for analysis. The risk of PE and severe PE was increased in OD pregnancies compared to NC pregnancies (pooled OR of all subgroups: 5.09, 95% CI: 4.29 – 6.04; I2 = 19% and OR: 7.42 (95% CI: 4.64–11.88; I2 = 49%). The pooled adjusted OR for PE was 3.24 (95% 2.74 – 3.83) for OD versus natural pregnancies.The risk of PE and severe PE was increased in OD pregnancies compared to IVF pregnancies (pooled OR of all subgroups: 2.96, 95% CI: 2.49 – 3.51; I2 = 51% and OR: 2.97, 95% CI: 2.15 – 4.11; I2 = 0%). The pooled adjusted OR for PE was 2.67 (95% 2.28 – 3.13) for OD versus IVF.The pooled prevalence of PE in singleton pregnancies after OD was 10.7% (95% CI 6.6 – 15.5) compared to 4.1% (95% CI 2.7 – 5.6) after IVF and 2% (95% CI 1.0 – 3.1) after NC. The prevalence in multiple pregnancies was 27.8% (95% CI 23.6 –32.2) after OD, 9.7% (95% CI 6.2 – 13.9) after IVF and 7.5% (95% CI 7.2 – 7.8) after NC. Limitations, reasons for caution The precise definition of PE is still a matter of debate. The different criteria could have affected the prevalence estimate. Wider implications of the findings: Nearly one in six women will suffer PE after OD. Women who can conceive naturally i.e. shared lesbian motherhood, should be discouraged to turn to OD. In women with premature ovarian failure factors that increase risk of PE should be avoided. We suggest therefore single embryo transfer. Trial registration number Not applicable