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Dumancic S, Pehlic M, Mijic P, Mimica MD, Zekic Tomas S, Marusic J. Histopathologic characteristics of term placentas in singleton pregnancies in women with endometriosis-related infertility after ART treatment: case-control study. J Matern Fetal Neonatal Med 2024; 37:2385451. [PMID: 39128873 DOI: 10.1080/14767058.2024.2385451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVES Endometriosis is one of the leading causes of infertility, due to negative impact on ovarian folliculogenesis and endometrial receptivity. Literature show that endometriosis could be associated with perinatal complications such as preterm birth (PTB) and preeclampsia (PE). Authors hypothesized that women with endometriosis-related infertility conceived by assisted reproductive technology (ART) treatment have higher frequency of placental disorders. Main outcome is the occurrence of histopathologic alterations of term placentas in singleton pregnancies of women with endometriosis conceived by ART treatment, compared to healthy women with infertility due to male factor (MF) conceived by ART and to healthy women with spontaneous pregnancies. Secondary outcome include the occurrence of perinatal complications and the relationship of endometriosis and placental histopathologic characteristics. METHODS Single-center, case-control study of term placentas that were collected within Department of Obstetrics and Gynecology of University Hospital Center (UHC) Split and analyzed in the Pathology department of the same hospital, by one senior perinatal pathologist. Histopathologic analysis was reported using Amsterdam Placental Workshop Group Consensus. All the noted placental lesions were divided into following categories: anatomic, inflammatory, villous maturation and vascular malperfusion disorders. Required sample size was 80 placentas, and study results were reported with descriptives, and analyzed with chi-squared, Fisher's exact test and Kruskal-Wallis ANOVA. Multivariate regression analysis was carried with adjustment for confounding factors. Ethics approval: Class n. 520-03/24-01/83. RESULTS Study included term placentas of 107 women, of which 36 were women with endometriosis conceived by ART, 31 were healthy women with MF infertility conceived by ART and 40 healthy women with spontaneous pregnancies. Endometriosis women were predominantly primiparas, with longer infertility duration. Endometriosis group had higher occurrence of early pregnancy bleeding and imminent preterm labor. Endometriosis and MF groups had higher occurrence of Cesarian delivery (CS), while endometriosis group had newborns with lowest birthweight. Endometriosis group had shorter placental cords (PC), higher rates of increased syncytial knotting and vascular malperfusion disorders (subchorionic and perivillous fibrin, intervillous thrombosis, high grade fetal vascular malperfusion). Finally, endometriosis is showed to be associated with increased syncytial knots' formation and PC hypercoiling, after adjustment for confounding factors in the multivariate regression analysis. CONCLUSIONS Despite low rates of perinatal complications, we report endometriosis to have higher occurrence of increased syncytial knotting and vascular malperfusion placental disorders, compared to control groups. Endometriosis is also associated with increased syncytial knotting and PC hypercoiling. Further studies are needed to elucidate the endometriosis impact on endometrial receptivity and immunopathogenesis in placental disorders and perinatal complications.HighlightsEndometriosis women were predominantly primiparas, with longer infertility duration.Endometriosis group had higher occurrence of early pregnancy bleeding and imminent preterm labor. Moreover, endometriosis and MF groups had higher occurrence of Cesarian delivery, while endometriosis group had newborns with lowest birthweight.Endometriosis group had shorter placental cords, higher rates of increased syncytial knotting and vascular malperfusion lesions.Endometriosis is showed to be associated with increased syncytial knots formation and hypercoiling of placental cord, after adjustment for confounding factor.
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Affiliation(s)
- S Dumancic
- Department of Obstetrics and Gynecology, University Hospital Center Split, Split, Croatia
| | - M Pehlic
- Department of Obstetrics and Gynecology, University Hospital Center Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - P Mijic
- Health Center of Split-Dalmatia County, Split, Croatia
| | - M D Mimica
- Department of Obstetrics and Gynecology, University Hospital Center Split, Split, Croatia
- University Department of Health Studies, University of Split, Split, Croatia
| | - S Zekic Tomas
- School of Medicine, University of Split, Split, Croatia
- Pathology Department, University Hospital Center Split, Split, Croatia
| | - J Marusic
- School of Medicine, University of Split, Split, Croatia
- University Department of Health Studies, University of Split, Split, Croatia
- Polyclinic Hormona, Split, Croatia
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Bhardwaj B, Singh S, Kumar S, Nandy S, Kumari A, Khardenavis N. Comparative study of difference in anatomy & histopathology of placenta & umbilical cord in natural pregnancy vs. IVF pregnancy & it's impact on fetal & maternal outcome. Eur J Obstet Gynecol Reprod Biol 2024; 298:204-207. [PMID: 38796875 DOI: 10.1016/j.ejogrb.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
AIM AND OBJECTIVES Comparison of naturally conceived pregnancy with IVFET pregnancy for feto-maternal outcome and morphology and histopathology of placenta & umbilical cord. METHODS 100 pregnant women were divided into 2 subsets of spontaneous pregnancy group (n = 50) and the IVFET pregnancy group (n = 50).The two groups were compared for Maternal age, parity, maternal weight gain, prepregnancy maternal BMI, gestational age, birth weight of baby, placental weight, placenta and umbilical cord cross sections, insertion site of the umbilical cord, and length of the umbilical cord. INCLUSION CRITERIA Patients registered at ANC OPD/ART centre of our institute and subsequently reporting to maternity ward/ labor room for delivery at our centre. EXCLUSION CRITERIA The pregnancies conceived after ART outside our institute, multifetal pregnancies. Study duration: 01 year Results: Our study revealed that spontaneous pregnancy group had less antenatal co-morbidities with more number of term vaginal deliveries and less intrapartum and neonatal complications compared to IVFET pregnancy women (p < 0.05). CONCLUSIONS Assisted reproductive technologies have an impact on placental growth and function in pregnancy. The occurrence of placental abnormalities were the most significant and pertinent finding in the IVF-ET placentas. On histopathological examination maternal vascular malperfusion and concomitant anomalies of the umbilical cord were most noticeable findings.
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Gök K, Ozden S. Decreased fetal thymus size in pregnancies after assisted reproductive technologies. J Matern Fetal Neonatal Med 2023; 36:2166401. [PMID: 36636015 DOI: 10.1080/14767058.2023.2166401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To compare the size of the fetal thymus, using both fetal thymic-thoracic ratio and fetal thymus transverse diameter values in Assisted reproductive technologies (ART) or naturally conceived pregnancies. METHODS In this retrospective study, fetal thymic-thoracic ratio and fetal thymus transverse diameter were evaluated in 204 pregnant women. Patients were examined in two groups. The study included 58 Intracytoplasmic sperm injection (ICSI) patients (study group) and 146 healthy pregnant women (control group). RESULTS Fetal thymic-thoracic ratio in ART pregnancies were found to be statistically significantly lower than that of the control group (p = .001). Also, the fetal thymus transverse diameter value was found to be statistically significantly lower in ART pregnancies compared to that of the control group (p = .001). CONCLUSIONS The size of the fetal thymus, manifested with a decrease in both fetal thymic-thoracic ratio and thymus transverse diameter values, decreased in ART pregnancies.
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Affiliation(s)
- Koray Gök
- Department of Obstetrics and Gynecology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Selçuk Ozden
- Department of Obstetrics and Gynecology, Sakarya University Faculty of Medicine, Sakarya, Turkey
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Párraga-Ros E, Álvarez-Martín Ú, Seva J, Coy P, Romar R. The impact of in vitro embryo production on placental and umbilical cord vascularization is minimized by the addition of reproductive fluids. Theriogenology 2023; 208:149-157. [PMID: 37329589 DOI: 10.1016/j.theriogenology.2023.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/10/2023] [Accepted: 05/29/2023] [Indexed: 06/19/2023]
Abstract
Animals born from in-vitro-produced (IVP) embryos show changes in the placenta and umbilical cord vascularization. This study compares the placental and umbilical vascular morphometry in pigs (n = 19) born through artificial insemination (AI group) or after transfer of IVP embryos cultured with (RF-IVP group) or without (C-IVP group) reproductive fluids. The relationship between vascular parameters and animal growth during the first year of life was also analyzed. Samples were collected at birth, fixed, paraffin-embedded, cut in sections, stained, and photographed for vascular and morphometric analysis with ImageJ® and Slide Viewer®. The average daily weight gain was individually scored from birth to the first year of life. No differences were found in placental vascular morphometry among groups, except for the vascular area of small vessels (arterioles, venules, and small vessels) that was higher in the C-IVP group. Regarding the umbilical cord, the values for perimeter (AI: 26.40 ± 3.93 mm; IVP: 30.51 ± 4.74 mm), diameter (AI: 8.35 ± 1.01 mm; IVP: 10.26 ± 1.85 mm), area (AI: 43.18 ± 12.87; IVP: 56.61 ± 14.89 mm2), and Wharton's jelly area (AI: 36.86 ± 12.04 mm2; IVP 48.88 ± 12.80 mm2) were higher in IVP-derived than AI-derived animals, whereas arterial and venous morphometric data were similar between groups. A correlation study showed that placental and umbilical cord vascular phenotypes affect the further growth of pigs. In conclusion, assisted reproductive technologies impact small caliber vessels in the placenta and morphometric parameters in the umbilical cord. The addition of reproductive fluids in IVP-embryo contributes to reduce the differences with in vivo-derived animals.
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Affiliation(s)
- Ester Párraga-Ros
- Department of Anatomy and Comparative Pathology, Faculty of Veterinary Medicine, University of Murcia, International Excellence Campus for Higher Education and Research (Campus Mare Nostrum), Murcia, Spain
| | - Úrsula Álvarez-Martín
- Department of Physiology, Faculty of Veterinary Medicine, University of Murcia, International Excellence Campus for Higher Education and Research (Campus Mare Nostrum), Murcia, Spain
| | - Juan Seva
- Department of Anatomy and Comparative Pathology, Faculty of Veterinary Medicine, University of Murcia, International Excellence Campus for Higher Education and Research (Campus Mare Nostrum), Murcia, Spain
| | - Pilar Coy
- Department of Physiology, Faculty of Veterinary Medicine, University of Murcia, International Excellence Campus for Higher Education and Research (Campus Mare Nostrum), Murcia, Spain; Institute for Biomedical Research of Murcia (IMIB), Murcia, Spain
| | - Raquel Romar
- Department of Physiology, Faculty of Veterinary Medicine, University of Murcia, International Excellence Campus for Higher Education and Research (Campus Mare Nostrum), Murcia, Spain; Institute for Biomedical Research of Murcia (IMIB), Murcia, Spain.
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Postpartum hemorrhage among twin pregnancies - Medically assisted versus spontaneously conceived. Placenta 2023; 132:15-19. [PMID: 36623414 DOI: 10.1016/j.placenta.2023.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/12/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
INTRODUCTION In singleton pregnancies, an increased risk of Postpartum hemorrhage (PPH) have been linked with assisted reproductive technology (ART) and abnormal placentation. It is unknown wheather such association exists in twin pregnancies conceived by Medically assisted reproduction (MAR). The aim of the current study was to compare maternal blood loss among twin pregnancies conceived by different types of MAR treatments to spontaneously conceived twins and to identify the cycle characteristics if an association exits. METHODS Retrospective study conducted on data collected between 2011 and 2020. The study cohort included all twin pregnancies conceived by MAR and born at our institution. Controls were spontaneously conceived twins matched for maternal age on a 1:2 (study: controls) ratio. RESULTS Overall 113 MAR twin births categorized into three groups; 25 ovulation induction, 59 fresh ART, 29 frozen-thawed ART cycles, and 226 controls were included. The incidence of PPH was higher among MAR twin pregnancies (5.3%) compared to the controls (4%). The highest incidence was observed among women in the frozen-thawed group (13.8%) which differed significantly compared with the controls (p = 0.024). A significant difference was also observed in the mean decrease of postpartum hemoglobin levels between these two groups (2.13 g/dL versus 1.3 g/dL respectively, p = 0.002). Blood transfusion was nearly 2.5 times more common in the frozen-thawed group (3.4%) compared to the control group (1.3%). DISCUSSION The present study demonstrates that frozen embryo transfer (FET) ART-conceived twin pregnancies are associated with a markedly increased rate of PPH compared to spontaneously conceived twins.
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Belak U, Pinter B, Ban Frangež H, Velikonja M, Korošec S. Pathology of the Placenta in Singletons after Assisted Reproductive Technology Compared to Singletons after Spontaneous Conception: A Systematic Review. Fetal Pediatr Pathol 2022; 42:438-449. [PMID: 36580043 DOI: 10.1080/15513815.2022.2157228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: We reviewed the literature comparing the pathological characteristics of singleton births conceived after assisted reproductive technology (ART) with those after spontaneous conception. Methods: We reviewed PubMed, EMBASE, Ovid MEDLINE, Google Scopus, Scholar, Cochrane Central Register of Controlled Trials and the Web of Science for the previous 10 years, up to November 2022. Results: Four eligible studies included 3445 placentas, 806 after ART (IVF/ICSI). Placentas after ART differed in frequency of retroplacental and marginal hematomas (p = 0.04), increased thickness (p = 0.02), higher overall occurrences of vascular and anatomical pathology (p < 0.001) and more frequent marginal (p = 0.001) and membranous (p = 0.02) umbilical cord insertion than placentas from non-ART pregnancies. Conclusion: Further research is needed to determine the extent to which these placental changes in ART pregnancies alter its function and pregnancy outcome.
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Affiliation(s)
- Urška Belak
- Department of Gyneacology and Obstetrics, General Hospital Celje, Celje, Slovenia.,Faculty of medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bojana Pinter
- Faculty of medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Human Reproduction, Division of Obstetrics and Gyneacology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Helena Ban Frangež
- Faculty of medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Human Reproduction, Division of Obstetrics and Gyneacology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mojca Velikonja
- Department of Pathology, Faculty of medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sara Korošec
- Faculty of medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Human Reproduction, Division of Obstetrics and Gyneacology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Manvelyan E, Millington KA, Abittan BS, Blitz MJ, Kwait B, Shan W, Goldman RH. Histopathologic evaluation of dichorionic twin placentas in unassisted and in vitro fertilized pregnancies affected by preeclampsia. J Matern Fetal Neonatal Med 2022; 35:10262-10270. [PMID: 36167346 DOI: 10.1080/14767058.2022.2121645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Pregnancies achieved with assisted reproductive technology have an increased risk of multiple gestations, preeclampsia, and placental morphologic abnormalities. Inflammatory processes affect dichorionic twin pregnancies disproportionately more than singleton gestations and have been associated with adverse pregnancy outcomes, such as fetal growth restriction and preeclampsia. Our objective is to investigate the placental morphology of dichorionic twin pregnancies complicated by preeclampsia conceived with in vitro fertilization (IVF) versus unassisted. METHODS This is a retrospective analysis of placentas from dichorionic twin pregnancies affected by preeclampsia conceived with IVF versus without assistance from 2010 to 2016 at a tertiary care university hospital. Placental pathology findings were analyzed both independently and in aggregate stratified into composite outcome scores using a modified placental synoptic framework. Individual placental abnormalities were grouped into composite categories based on the site of origin: anatomic placental abnormalities; maternal vascular malperfusion; placental villous maldevelopment; fetal vascular malperfusion; chronic utero-placental separation; maternal-fetal interface disturbance; inflammation of infectious etiology; and inflammation of idiopathic etiology. Placental histopathological statistical analysis was performed using Fisher's exact test. Demographic variables and pregnancy outcomes were compared between groups using the Student's t test or Mann-Whitney U test, where appropriate. p < .05 defined statistical significance. RESULTS Of 117 dichorionic twin pregnancies, 60 resulted from IVF (Group A) and 57 were conceived without assistance (Group B). Patients in Group A were older (36 [29-37] vs. 33 [32-38] respectively; p = .042) and less parous (18.3% vs. 38.6% percent parous in Group A and Group B, respectively p = .009) than Group B, respectively. No differences were found between groups regarding mode of delivery, gestational age at delivery, placental weight/birthweight, fetal growth restriction, and discordance of fetal growth. There were significantly more inflammatory changes of unknown etiology and composite inflammatory abnormalities in Group A versus Group B (26.7% vs. 10.5%, p = .02). The cumulative number of inflammatory abnormalities per patient had a significantly different distribution among groups (p = .005), and Composite Chronic Inflammation and Infection were found to be significantly more abundant in Group A versus Group B (p = .02). The distribution of placental composite anatomic placental abnormalities, maternal vascular malperfusion, placental villous maldevelopment, fetal vascular malperfusion, chronic utero-placental separation, or maternal-fetal interface disturbance was not statistically different between groups. The distribution of placental abnormalities was not different between groups for any individually analyzed pathological condition. Due to the relatively small sample size, adjustment for potential confounders was not performed. CONCLUSION Dichorionic twin pregnancies affected by preeclampsia are associated with more placental inflammatory abnormalities if conceived with IVF versus unassisted. Further research is needed to ascertain the underlying mechanisms of these observed differences.
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Affiliation(s)
- Evelina Manvelyan
- Department of Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell South Shore University Hospital, Bay Shore, NY, USA
| | - Karmaine A Millington
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Baruch S Abittan
- Department of Obstetrics & Gynecology Division of Reproductive Endocrinology and Infertility Zucker School of Medicine at, Hofstra/Northwell. Manhasset, New York, NY, USA
| | - Matthew J Blitz
- Department of Obstetrics & Gynecology Division of Maternal-Fetal Medicine Zucker School of Medicine at, Hofstra/Northwell, Bay Shore, NY, USA
| | - Brittany Kwait
- Donald and Barbara Zucker School of Medicine at, Hofstra/Northwell, Manhasset, NY, USA
| | - Weiwei Shan
- Department of Obstetrics & Gynecology, Biostatistics Unit at The Feinstein School of Medical Research, New York, NY, USA
| | - Randi H Goldman
- Department of Obstetrics & Gynecology Division of Reproductive Endocrinology and Infertility Zucker School of Medicine at, Hofstra/Northwell. Manhasset, New York, NY, USA
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Luke B, Brown MB, Wantman E, Schymura MJ, Browne ML, Fisher SC, Forestieri NE, Rao C, Nichols HB, Yazdy MM, Gershman ST, Sacha CR, Williams M, Ethen MK, Canfield MA, Doody KJ, Eisenberg ML, Baker VL, Williams C, Sutcliffe AG, Richard MA, Lupo PJ. The risks of birth defects and childhood cancer with conception by assisted reproductive technology. Hum Reprod 2022; 37:2672-2689. [PMID: 36112004 PMCID: PMC9960485 DOI: 10.1093/humrep/deac196] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/04/2022] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Is there an association between fertility status, method of conception and the risks of birth defects and childhood cancer? SUMMARY ANSWER The risk of childhood cancer had two independent components: (i) method of conception and (ii) presence, type and number of birth defects. WHAT IS KNOWN ALREADY The rarity of the co-occurrence of birth defects, cancer and ART makes studying their association challenging. Prior studies have indicated that infertility and ART are associated with an increased risk of birth defects or cancer but have been limited by small sample size and inadequate statistical power, failure to adjust for or include plurality, differences in definitions and/or methods of ascertainment, lack of information on ART treatment parameters or study periods spanning decades resulting in a substantial historical bias as ART techniques have improved. STUDY DESIGN, SIZE, DURATION This was a population-based cohort study linking ART cycles reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) from 1 January 2004 to 31 December 2017 that resulted in live births in 2004-2018 in Massachusetts and North Carolina and live births in 2004-2017 in Texas and New York. A 10:1 sample of non-ART births were chosen within the same time period as the ART birth. Non-ART siblings were identified through the ART mother's information. Children from non-ART births were classified as being born to women who conceived with ovulation induction or IUI (OI/IUI) when there was an indication of infertility treatment on the birth certificate, and the woman did not link to the SART CORS; all others were classified as being naturally conceived. PARTICIPANTS/MATERIALS, SETTING, METHODS The study population included 165 125 ART children, 31 524 non-ART siblings, 12 451 children born to OI/IUI-treated women and 1 353 440 naturally conceived children. All study children were linked to their respective State birth defect registries to identify major defects diagnosed within the first year of life. We classified children with major defects as either chromosomal (i.e. presence of a chromosomal defect with or without any other major defect) or nonchromosomal (i.e. presence of a major defect but having no chromosomal defect), or all major defects (chromosomal and nonchromosomal), and calculated rates per 1000 children. Logistic regression models were used to generate adjusted odds ratios (AORs) and 95% CIs of the risk of birth defects by conception group (OI/IUI, non-ART sibling and ART by oocyte source and embryo state) with naturally conceived children as the reference, adjusted for paternal and maternal ages; maternal race and ethnicity, education, BMI, parity, diabetes, hypertension; and for plurality, infant sex and State and year of birth. All study children were also linked to their respective State cancer registries. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs of cancer by birth defect status (including presence of a defect, type and number of defects), and conception group. MAIN RESULTS AND THE ROLE OF CHANCE A total of 29 571 singleton children (2.0%) and 3753 twin children (3.5%) had a major birth defect (chromosomal or nonchromosomal). Children conceived with ART from autologous oocytes had increased risks for nonchromosomal defects, including blastogenesis, cardiovascular, gastrointestinal and, for males only, genitourinary defects, with AORs ranging from 1.22 to 1.85; children in the autologous-fresh group also had increased risks for musculoskeletal (AOR 1.28, 95% CI 1.13, 1.45) and orofacial defects (AOR 1.40, 95% CI 1.17, 1.68). Within the donor oocyte group, the children conceived from fresh embryos did not have increased risks in any birth defect category, whereas children conceived from thawed embryos had increased risks for nonchromosomal defects (AOR 1.20, 95% CI 1.03, 1.40) and blastogenesis defects (AOR 1.74, 95% CI 1.14, 2.65). The risk of cancer was increased among ART children in the autologous-fresh group (HR 1.31, 95% CI 1.08, 1.59) and non-ART siblings (1.34, 95% CI 1.02, 1.76). The risk of leukemia was increased among children in the OI/IUI group (HR 2.15, 95% CI 1.04, 4.47) and non-ART siblings (HR 1.63, 95% CI 1.02, 2.61). The risk of central nervous system tumors was increased among ART children in the autologous-fresh group (HR 1.68, 95% CI 1.14, 2.48), donor-fresh group (HR 2.57, 95% CI 1.04, 6.32) and non-ART siblings (HR 1.84, 95% CI 1.12, 3.03). ART children in the autologous-fresh group were also at increased risk for solid tumors (HR 1.39, 95% CI 1.09, 1.77). A total of 127 children had both major birth defects and cancer, of which 53 children (42%) had leukemia. The risk of cancer had two independent components: (i) method of conception (described above) and (ii) presence, type and number of birth defects. The presence of nonchromosomal defects increased the cancer risk, greater for two or more defects versus one defect, for all cancers and each type evaluated. The presence of chromosomal defects was strongly associated with cancer risk (HR 8.70 for all cancers and HR 21.90 for leukemia), further elevated in the presence of both chromosomal and nonchromosomal defects (HR 21.29 for all cancers, HR 64.83 for leukemia and HR 4.71 for embryonal tumors). Among the 83 946 children born from ART in the USA in 2019 compared to their naturally conceived counterparts, these risks translate into an estimated excess of 761 children with major birth defects, 31 children with cancer and 11 children with both major birth defects and cancer. LIMITATIONS, REASONS FOR CAUTION In the SART CORS database, it was not possible to differentiate method of embryo freezing (slow freezing versus vitrification), and data on ICSI were only available in the fresh embryo ART group. In the OI/IUI group, it was not possible to differentiate type of non-ART treatment utilized, and in both the ART and OI/IUI groups, data were unavailable on duration of infertility. Since OI/IUI is underreported on the birth certificate, some OI/IUI children were likely included among the naturally conceived children, which will decrease the difference between all the groups and the naturally conceived children. WIDER IMPLICATIONS OF THE FINDINGS The use of ART is associated with increased risks of major nonchromosomal birth defects. The presence of birth defects is associated with greater risks for cancer, which adds to the baseline risk in the ART group. Although this study does not show causality, these findings indicate that children conceived with ART, non-ART siblings, and all children with birth defects should be monitored more closely for the subsequent development of cancer. STUDY FUNDING/COMPETING INTEREST(S) This project was supported by grant R01 HD084377 from the National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Child Health and Human Development, or the National Institutes of Health, nor any of the State Departments of Health which contributed data. M.L.E. reports consultancy for Ro, Hannah, Dadi, Sandstone and Underdog; presidency of SSMR; and SMRU board member. The remaining authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Barbara Luke
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Morton B Brown
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Maria J Schymura
- New York State Department of Health, New York State Cancer Registry, Albany, NY, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Albany, Rensselaer, NY, USA
| | - Marilyn L Browne
- Department of Epidemiology and Biostatistics, School of Public Health, University of Albany, Rensselaer, NY, USA
- New York State Department of Health, Birth Defects Registry, Albany, NY, USA
| | - Sarah C Fisher
- New York State Department of Health, Birth Defects Registry, Albany, NY, USA
| | - Nina E Forestieri
- North Carolina Department of Health and Human Services, Birth Defects Monitoring Program, State Center for Health Statistics, Raleigh, NC, USA
| | - Chandrika Rao
- North Carolina Central Cancer Registry, Raleigh, NC, USA
| | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mahsa M Yazdy
- Massachusetts Department of Public Health, Massachusetts Center for Birth Defects Research and Prevention, Boston, MA, USA
| | - Susan T Gershman
- Massachusetts Department of Public Health, Massachusetts Cancer Registry, Office of Data Management and Outcomes Assessment, Boston, MA, USA
| | - Caitlin R Sacha
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Melanie Williams
- Texas Department of State Health Services, Cancer Epidemiology and Surveillance Branch, Texas Health and Human Services, Austin, TX, USA
| | - Mary K Ethen
- Texas Department of State Health Services, Birth Defects Epidemiology and Surveillance Branch, Austin, TX, USA
| | - Mark A Canfield
- Texas Department of State Health Services, Birth Defects Epidemiology and Surveillance Branch, Austin, TX, USA
| | | | - Michael L Eisenberg
- Division of Male Reproductive Medicine and Surgery, Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carrie Williams
- Policy, Practice, and Population Unit, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Alastair G Sutcliffe
- Policy, Practice, and Population Unit, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Melissa A Richard
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA
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Vrooman LA, Rhon-Calderon EA, Suri KV, Dahiya AK, Lan Y, Schultz RM, Bartolomei MS. Placental Abnormalities are Associated With Specific Windows of Embryo Culture in a Mouse Model. Front Cell Dev Biol 2022; 10:884088. [PMID: 35547813 PMCID: PMC9081528 DOI: 10.3389/fcell.2022.884088] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/07/2022] [Indexed: 11/20/2022] Open
Abstract
Assisted Reproductive Technologies (ART) employ gamete/embryo handling and culture in vitro to produce offspring. ART pregnancies have an increased risk of low birth weight, abnormal placentation, pregnancy complications, and imprinting disorders. Embryo culture induces low birth weight, abnormal placental morphology, and lower levels of DNA methylation in placentas in a mouse model of ART. Whether preimplantation embryos at specific stages of development are more susceptible to these perturbations remains unresolved. Accordingly, we performed embryo culture for several discrete periods of preimplantation development and following embryo transfer, assessed fetal and placental outcomes at term. We observed a reduction in fetal:placental ratio associated with two distinct windows of preimplantation embryo development, one prior to the morula stage and the other from the morula to blastocyst stage, whereas placental morphological abnormalities and reduced imprinting control region methylation were only associated with culture prior to the morula stage. Extended culture to the blastocyst stage also induces additional placental DNA methylation changes compared to embryos transferred at the morula stage, and female concepti exhibited a higher loss of DNA methylation than males. By identifying specific developmental windows of susceptibility, this study provides a framework to optimize further culture conditions to minimize risks associated with ART pregnancies.
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Affiliation(s)
- Lisa A. Vrooman
- Department of Cell and Developmental Biology, Perelman School of Medicine, Epigenetics Institute, University of Pennsylvania, Philadelphia, PA, United States
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, United States
| | - Eric A. Rhon-Calderon
- Department of Cell and Developmental Biology, Perelman School of Medicine, Epigenetics Institute, University of Pennsylvania, Philadelphia, PA, United States
| | - Kashviya V. Suri
- Department of Cell and Developmental Biology, Perelman School of Medicine, Epigenetics Institute, University of Pennsylvania, Philadelphia, PA, United States
| | - Asha K. Dahiya
- Department of Cell and Developmental Biology, Perelman School of Medicine, Epigenetics Institute, University of Pennsylvania, Philadelphia, PA, United States
| | - Yemin Lan
- Department of Cell and Developmental Biology, Perelman School of Medicine, Epigenetics Institute, University of Pennsylvania, Philadelphia, PA, United States
| | - Richard M. Schultz
- Department of Biology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, United States
| | - Marisa S. Bartolomei
- Department of Cell and Developmental Biology, Perelman School of Medicine, Epigenetics Institute, University of Pennsylvania, Philadelphia, PA, United States
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Aboulghar M, Aboulghar M. Placental pathology after assisted reproduction: impact on the outcome of pregnancy. Fertil Steril 2022; 117:769-770. [DOI: 10.1016/j.fertnstert.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 11/04/2022]
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