Elsevier

Fertility and Sterility

Volume 112, Issue 2, August 2019, Pages 283-290.e2
Fertility and Sterility

Original article
Maternal and neonatal outcomes associated with trophectoderm biopsy

https://doi.org/10.1016/j.fertnstert.2019.03.033Get rights and content
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Objective

To assess whether pregnancies achieved with trophectoderm biopsy for preimplantation genetic testing (PGT) have different risks of adverse obstetric and neonatal outcomes compared with pregnancies achieved with IVF without biopsy.

Design

Observational cohort.

Setting

University-affiliated fertility center.

Patient(s)

Pregnancies achieved via IVF with PGT (n = 177) and IVF without PGT (n = 180) that resulted in a live birth.

Intervention(s)

None.

Main Outcome Measure(s)

Maternal outcomes including preeclampsia and placenta previa and neonatal outcomes including birth weight and birth defects.

Result(s)

There was a statistically significant increase in the risk of preeclampsia among IVF+PGT pregnancies compared with IVF without PGT pregnancies, with an incidence of 10.5% versus 4.1% (adjusted odds ratio [aOR] = 3.02; 95% confidence interval [95% CI], 1.10, 8.29). The incidence of placenta previa was 5.8% in IVF+PGT pregnancies versus 1.4% in IVF without PGT pregnancies (aOR = 4.56; 95% CI, 0.93, 22.44). Similar incidences of gestational diabetes, preterm premature rupture of membranes, and postpartum hemorrhage were observed. IVF+PGT and IVF without PGT neonates did not have a significantly different gestational age at delivery or rate of preterm birth, low birth weight, neonatal intensive care unit admission, neonatal morbidities, or birth defects. All trends, including the significantly increased risk of preeclampsia in IVF+PGT pregnancies, persisted upon stratification of analysis to only singleton live births.

Conclusion(s)

To date, this is the largest and most extensively controlled study examining maternal and neonatal outcomes after trophectoderm biopsy. There was a statistically significant three-fold increase in the odds of preeclampsia associated with trophectoderm biopsy. Given the rise in PGT use, further investigation is warranted.

Resultados maternos y neonatales asociados con biopsia de trofectodermo

Objetivo

Evaluar si los embarazos logrados con la biopsia de trofoectodermo para pruebas genéticas preimplantacionales (PGT) tienen diferentes riesgos de resultados adversos obstétricos y neonatales en comparación con los embarazos logrados con la FIV sin biopsia.

Diseño

Cohorte observacional.

Lugar

Centro de fertilidad afiliado a la universidad.

Paciente (s)

Embarazos logrados a través de fecundación in vitro (FIV) con PGT (n = 177) y FIV sin PGT (n = 180) que resultaron en un nacido vivo.

Intervención (es)

Ninguna.

Principal (s) medida (s) de resultado

Resultados maternos que incluyen preeclampsia y placenta previa y resultados neonatales que incluyen el peso y defectos de nacimiento.

Resultado (s)

Hubo un aumento estadísticamente significativo en el riesgo de preeclampsia entre los embarazos de FIV+PGT en comparación con los embarazos de FIV sin PGT, con una incidencia de 10,5% versus 4,1% (odds ratio ajustado [aOR] = 3,02; intervalo de confianza del 95% [95% CI], 1,10, 8,29). La incidencia de placenta previa fue del 5,8% en los embarazos con FIV+PGT versus 1,4% en los embarazos con FIV sin PGT (aOR = 4,56; 95% CI, 0,93, 22,44). Incidencias similares de diabetes gestacional, rotura prematura de membranas prematuras y hemorragia posparto fueron observados. La FIV con PGT y la FIV sin PGT no tuvieron una edad gestacional significativamente diferente en el momento del parto o la tasa del nacimiento prematuro, bajo peso al nacer, ingreso a la unidad de cuidados intensivos neonatales, morbilidad neonatal o defectos de nacimiento. Todas las tendencias, incluyendo el aumento significativo del riesgo de preeclampsia en los embarazos de FIVPGT persistió tras la estratificación del análisis solo para recién nacidos únicos.

Conclusión (s)

Hasta la fecha, este es el estudio más grande y más ampliamente controlado que examina los resultados maternos y neonatales después de la biopsia de trofectodermo. Hubo un aumento triple estadísticamente significativo en las probabilidades de preeclampsia asociada con la biopsia de trofectodermo.

Dado el aumento en el uso de PGT, se justifica una mayor investigación.

Key Words

Preimplantation genetic testing
trophectoderm biopsy
in vitro fertilization
maternal outcomes
neonatal outcomes
preeclampsia

Cited by (0)

Funded by award no. P01 HD 065647-01A1 from the National Institute of Child and Human Development (to V.L.B.), a Heisenberg Fellowship Award from the German Research Foundation (VE490/8-1; to F.v.V.-H.), and a MedScholars fellowship from the Stanford Medical Scholars Research Program (to W.Y.Z.). The use of REDCap was supported by a Stanford Clinical and Translational Science Award no. UL1 TR001085 from the National Institutes of Health National Center for Research Resources.

W.Y.Z. has nothing to disclose. F.v.V.-H. has nothing to disclose. K.I.K. has nothing to disclose. R.R.F. has nothing to disclose. Q.Z. has nothing to disclose. V.L.B. has nothing to disclose.