Assisted reproductive technologies (ART) and placental abnormalities

Elizabeth Cochrane; Christine Pando; Gregory W. Kirschen; Devon Soucier; Anna Fuchs; David J. Garry

doi:10.1515/jpm-2020-0141

Article

Assisted reproductive technologies (ART) and placental abnormalities

Elizabeth Cochrane , Christine Pando , Gregory W. Kirschen , Devon Soucier , Anna Fuchs and David J. Garry

Published/Copyright: August 10, 2020

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From the journal Journal of Perinatal Medicine Volume 48 Issue 8

Abstract

Objectives

Assisted reproductive technologies (ART) may be associated with placental abnormalities including placenta previa, umbilical cord abnormalities, and placental abruption. Our study evaluates the relationship between ART and placental abnormalities compared with spontaneously conceived controls.

Methods

An IRB-approved cohort study was conducted including women who delivered between January 2013 and December 2018. We excluded delivery prior to 23 weeks and known fetal anomalies. Patients were matched with controls (2:1) for parity, age, and mode of delivery. Controls were women who had spontaneously conceived and delivered immediately preceding and following the index delivery. The primary outcome was placental abnormalities found on both antenatal ultrasound and pathology in ART gestations compared with spontaneously conceived gestations.

Results

There were 120 ART pregnancies and 240 matched control pregnancies identified. The groups were similar for parity, BMI, comorbidities, number of multiples, mode of delivery, and female newborns. The ART group had a higher maternal age (37.1±5 y vs. 30.0±5 y; p<0.001), greater preterm birth (29 vs. 6%; p<0.001), and lower BW (2,928±803 g vs. 3,273±586 g; p<0.001). The ART group had a higher incidence of placenta previa on ultrasound (4.0 vs. 0.4%, p=0.01), adherent placentas at delivery (3 vs. 0% p=0.014), placental abruption (2 vs. 0%; p=0.04), as well as an increased rate of velamentous cord insertion (12 vs. 3%, p<0.001) and marginal cord insertion (28 vs. 15%, p=0.002). ART demonstrated a two-fold likelihood of abnormal placental pathology.

Conclusions

ART is associated with increased rate of placental abnormalities, including abnormal umbilical cord insertion and increased rates of adherent placentation. This information may be beneficial in planning and surveillance in patients with ART pregnancies.

Keywords: assisted reproductive technologies; placenta; umbilical cord

Corresponding author: David J. Garry, DO FACOG, Department of Obstetrics & Gynecology and Reproductive Medicine, Renaissance School of Medicine at Stony Brook University, HSC T-9 Room 030, 101 Nicolls Road, Stony Brook, NY, 11794, USA. Phone: +1 641 444 7650, Fax: +1 631 444 3944, E-mail: David.Garry@stonybrookmedicine.edu

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The study was approved by the Institutional Review Board.

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Received: 2020-03-30

Accepted: 2020-07-21

Published Online: 2020-08-10

Published in Print: 2020-10-25

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https://doi.org/10.1515/jpm-2020-0141

Keywords for this article

assisted reproductive technologies; placenta; umbilical cord