Probable clinical and paraclinical factors of the occurrence of gestational hypertensive disorders in pregnant women after the use of assisted reproductive technologies

Abstract

The objective: to establish probable clinical and paraclinical risk factors for the development of gestational hypertensive disorders (GHD) in pregnant women after the use of assisted reproductive technologies (ART).Materials and methods. A clinical and statistical analysis of the birth histories of 362 women who became pregnant after the use of ART was carried out. Among them, 103 patients with had pre-gestational arterial hypertension (AH) and were included in the 1st group, 51 patients with increased blood pressure for the first time after 20 weeks of pregnancy – GHD, were included in the 2nd group, and 208 women without hypertensive disorders (HD) neither before nor after pregnancy were included in the 3rd group (control one). To determine the prognostic value of probable clinical and paraclinical risk factors for the GHD development in patients after ART, the following factors were analyzed: place of residence, age during pregnancy, obstetric, gynecological and reproductive history, marriage status, body mass index. The assess of commonly known factors was also evaluated for the risk of development for GHD. The influence of method of artificial insemination is also considered.Statistical processing of the results was carried out using standard Microsoft Excel 7.0 and “Statistica 6.0” programs. Results. The research demonstrated that HD is a common complication in pregnant women after the use of ART and accounts for 42.5 %. The frequency of women ≥40 years old was significantly higher in the 1st (42.8 %) and 2nd (25.5 %) groups than in the 3d one (15.5 %), as well as the prevalence of secondary infertility among the examined female patients – 23.3 %, 37.2 % and 6.3 %, respectively. Diabetes was found in women of the 1st (7.8 %) and 2nd (5.9 %) groups statistically more often compared to the control group (1.9 %), multiple pregnancy – in 45.6 %, 52.9 % and 27.0 % cases, respectively; 11.8% of patients in the 2nd group were diagnosed with autoimmune diseases.In patients with pregestational AH and GHD there was the high frequency of secondary infertility which is significantly more compared to the control group (p<0.05). Therefore, it can be assumed that this factor may influence the development of GHD in the future.The use of donor eggs was significantly more frequent in women of the 2nd group (21.5 %) compared to patients of the 1st (4.9 %) and control (5.3 %) groups (p<0.05). Transfer of cryopreserved embryos was used in 54.3 % of pregnant women of the 1st group and in 45.1 % of pregnant women in the 2nd group, which is reliable compared to the indicators of the control group (17.7 %; p<0.05). This makes possible to state that the use of donor eggs and the transfer of cryopreserved embryos can lead to an increase in the risk of GHD development in the future.In the group of pregnant women with pregestational AH, there were significantly more patients with an intergenetic interval of 10 years or more. This suggests that a large intergenetic interval may have an adverse effect on the progression of hypertension during pregnancy. Conclusions. The clinical and paraclinical risk factors for the development of gestational hypertensive disorders in women who became pregnant after the use of ART were determined – pre-gestational arterial hypertension, diabetes, autoimmune diseases, multiple pregnancy after the use of ART, as well as moderate risk factors: the first pregnancy from “this partner” and the patient’s age ≥40 years. Additional risk factors for the development of gestational hypertensive disorders were established – pathological childbirth during previous pregnancies, secondary infertility, use of donor eggs, transfer of cryopreserved embryos, intergenetic interval of 10 years or more.