The use of preimplantation genetic testing (PGT) is increasing rapidly, having gone from 4% of all cycles in 2005 to over 22% in 2015. Despite this increasing use, maternal and neonatal outcomes for pregnancies achieved via in vitro fertilization (IVF) with PGT have very little assessment. As trophectoderm biopsy removes cells that are destined to form the placenta, there is potential for an increased risk of adverse pregnancy outcomes associated with abnormal implantation. This cohort study assesses whether pregnancies achieved with trophectoderm biopsy for PGT have different risks of adverse obstetric and neonatal outcomes compared with pregnancies achieved with IVF without biopsy. The primary aim of the study was to examine obstetric outcomes, specifically the incidence of preeclampsia or the presence of hypertension after 20 weeks of gestation in a previously normotensive woman and proteinuria. New-onset hypertension in the absence of proteinuria also qualified for the diagnosis of preeclampsia if it included one of the following symptoms: thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms. Additional obstetric outcomes examined included the development of gestational diabetes, preterm premature rupture of membranes, postpartum hemorrhage, cesarean delivery, and induction of labor. The secondary aim of the study was to examine the neonatal outcomes. Incidence of preterm birth (<37 weeks), birth weight, birth defects, Apgar score at 5 minutes, neonatal intensive care unit admission, neonatal jaundice, and neonatal morbidity were all assessed. Enrollment from women receiving fertility care at Stanford were enrolled from October 2011 and continued through deliveries projected to occur by the end of December 2017. All women with a viable pregnancy at approximately 8 weeks of gestation were eligible to participate. A total of 357 live births, 177 IVF + PGT and 180 IVF without PGT, were included in the analysis. The indications for PGT were aneuploidy, monogenetic disorder, recurrent pregnancy loss, advanced maternal age, sex selection, previous IVF failure, and elective, with some women having multiple indications for PGT. There were no significant differences in the women's age, body mass index, parity, race/ethnicity, incidence of hypertensive disease in previous pregnancy, or rate of chronic hypertension. The incidence of preeclampsia among IVF + PGT women was 10.5%, which was a statistically significant increase when compared with 4.1% among IVF without PGT women. However, there were no observed statistically different incidences of other placental disorders or hypertensive disorders of pregnancy. Neonatal outcomes demonstrated a similar mean gestational age for both IVF + PGTand IVF without PGT neonates. There was a significantly higher proportion of male neonates in the IVF + PGT group, even with the 26 participants with the "sex selection" indication removed (61% male vs 39% female). No statistically significant differences in the incidences of birth defects existed in our main analysis, but subanalysis of only the FET cohort showed a significantly increased odds of birth defects among IVF + PGT neonates. This cohort study is unique in several aspects, as inclusion pool comprises participants with live births from autologous oocytes and adjusted formultiple confounders that have been previously demonstrated to increase the risk for adverse pregnancy outcomes, such as preeclampsia and placental disorders.
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