The Role of Embryonic Origin in Preeclampsia: A Comparison of Autologous In Vitro Fertilization and Ovum Donor Pregnancies

Klatsky, Peter C. MD, MPH; Delaney, Shani S. MD; Caughey, Aaron B. MD, PhD; Tran, Nam D. MD, PhD; Schattman, Glenn L. MD; Rosenwaks, Zev MD

doi: 10.1097/AOG.0b013e3181fb8e59
Original Research

OBJECTIVE: To compare the risk of gestational hypertension and preeclampsia in pregnancies conceived through standard in vitro fertilization (IVF) using autologous oocytes with pregnancies conceived using donated oocytes.

METHODS: We conducted a retrospective, matched cohort study of women undergoing IVF using autologous compared with donor oocytes between 1998 and 2005. Women with live births resulting from oocyte donor pregnancies were matched for age and plurality (singleton or twin) with women undergoing autologous IVF. Primary outcomes were the incidence of preeclampsia or gestational hypertension (with and without proteinuria) in the third trimester. Data on preterm delivery, low birth weight, and embryo cryopreservation were also recorded.

RESULTS: Outcome data were available for 158 pregnancies, including 77 ovum-donor recipient pregnancies and 81 pregnancies using autologous oocytes. There were no differences in age, parity, and gestational type between the two cohorts. The incidence of gestational hypertension and preeclampsia was significantly higher in ovum-donor recipients compared with women undergoing autologous IVF (24.7% compared with 7.4%, P<.01, and 16.9% compared with 4.9%, P=.02, respectively). Ovum-donor recipients were more likely than women undergoing autologous IVF to deliver prematurely (34% compared with 19%). This association remained after controlling for multiple gestation (odds ratio 2.6, 95% confidence interval 1.04–6.3). Sixteen pregnancies from cryopreserved embryos were more likely to have hypertensive disorders of pregnancy (odds ratio 5.0, 95% confidence interval 1.2–20.5).

CONCLUSION: Pregnancies derived from donor oocytes and cryopreserved–thawed embryos may be at a higher risk for hypertensive disorders of pregnancy. These findings inform future research and help counsel women using assisted reproductive technology.

LEVEL OF EVIDENCE: II

Pregnancies from donor oocytes and cryopreserved embryos may be at increased risk for preeclampsia, gestational hypertension, and preterm labor compared with agematched in vitro fertilization pregnancies.

From the Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; the Department of Obstetrics and Gynecology, University of Washington, Seattle, Seattle, Washington; Department of Obstetrics and Gynecology, Oregon Health Sciences University, Portland, Oregon; the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California; and the Department of Reproductive Endocrinology and Infertility, Weill Cornell Medical College, New York, New York.

Corresponding author: Peter C. Klatsky, MD, MPH, Women and Infants Hospital, Division of Reproductive Endocrinology and Infertility, 101 Dudley St, Providence, RI 02903; e-mail: pklatsky@gmail.com.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2010 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.