Pregnancy Complications

Perinatal outcome of singletons born after IVF have been recently assessed in a meta-analysis (81). The study compared for the period 1978-2002, a cohort of 12,283 IVF and ICSI singletons to a control cohort of 1.9 million spontaneously conceived singletons, matched for maternal age and parity. In comparison with spontaneous conceptions, IVF and ICSI pregnancies were associated with significantly higher odds of each of the perinatal outcome parameters studied: perinatal mortality, pre-term delivery, low birth weight, very low birth weight, and small gestational age. In the ART singletons, the prevalence was higher for early pre-term delivery, spontaneous pre-term delivery, placenta praevia, gestational diabetes, pre-eclampsia, and neonatal intensive care admission. IVF patients must be counseled about these adverse perinatal outcomes, and obstetricians should manage these pregnancies as high risk. A systematic review by Helmerhorst et al. of perinatal outcome of singletons and twins after ART confirmed the data for singletons of the Jackson et al. meta-analysis (82). The systematic review comprises 25 studies (17 with matched and 8 with non-matched controls) published between 1985 and 2002. For singletons, the review indicated a significant increased relative risk for very pre-term (<32 weeks) and pre-term (<37 weeks) deliveries. The relative risks were also increased for very low birth weight (<1500g), low birth weight (<2500 g), small for gestational age, caesarean section, admission to neonatal intensive care unit, and perinatal mortality. Matched and non-matched studies gave similar results. For matched and non-matched studies of twin gestations, the above-mentioned outcome parameters were similar between ART and control pregnancies. Perinatal mortality was lower in assisted conception twins compared to natural conception twins.

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