Is in vitro fertilization associated with preeclampsia? A propensity score matched study

BMC Pregnancy and Childbirth

Haruhiko Sago³  Kazuto Kozuka¹  Yuji Yamanobe¹  Kosuke Taniguchi³  Seung Chik Jwa²  Tomo Suzuki³  Takeo Fujiwara²  Noriyoshi Watanabe³ 

[1] Department of Information Technology and Management, National Center for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo 157-8535, Japan;Department of Social Medicine, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo 157-8535, Japan;Department of Maternal-Fetal Neonatal Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo 157-8535, Japan

关键词: Assisted reproductive technology;    Propensity score;    Preeclampsia;    In vitro fertilization;    Blood pressure;   

Others  :  1127593
DOI  :  10.1186/1471-2393-14-69

 received in 2013-02-22, accepted in 2014-02-10,  发布年份 2014

【 摘 要 】

Background

Although an increased risk of preeclampsia in pregnancies conceived by in vitro fertilization (IVF) has been reported, it remains unknown whether IVF is associated with preeclampsia. In the present study, we sought to investigate whether IVF is associated with preeclampsia in pregnant women using propensity score matching analysis.

Methods

This study included 3,084 pregnant women who visited the National Center for Child Health and Development before 20 weeks of gestation without hypertension or renal disease and delivered a singleton after 22 weeks of gestation between 2009 and 2011. Of the 3084 patients, 474 (15.4%) conceived by IVF (IVF group) and 2,610 (84.6%) conceived without IVF (non-IVF group). The propensity score for receiving IVF was estimated using multiple logistic regression with 27 maternal and paternal variables. This model yielded a c-statistic of 0.852, indicating a strong ability to differentiate between those conceiving with and without IVF. The association between IVF and onset of preeclampsia was assessed by the propensity matched sample (pair of N = 474).

Results

There were 46 preeclampsia cases (1.5%) in the total study population, with a higher proportion of cases in the IVF group (15 cases, 3.2%) than the non-IVF group (31 cases, 1.2%). Before propensity score matching, the IVF group was 2.72 (95% confidence intervals [CI]: 1.46-5.08) times more likely to have preeclampsia when unadjusted, and 2.32 (95% CI: 1.08-4.99) times more likely to have preeclampsia when adjusted for maternal and paternal variables by logistic regression. After propensity score matching, the IVF group did not show a significantly greater association with preeclampsia compared to the non-IVF group (odds ratio: 2.50, 95% CI: 0.49-12.89), although point estimates showed a positive direction.

Conclusions

Propensity score matching analysis revealed that the association between IVF and preeclampsia became weaker than when conventional adjustments are made in multivariate logistic regression analysis, suggesting that the association between IVF and preeclampsia might be confounded by residual unmeasured factors.

【 授权许可】

   
2014 Watanabe et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Raymond D, Peterson E: A critical review of early-onset and late-onset preeclampsia. Obstet Gynecol Surv 2011, 66(8):497-506.
• [2]Sibai B, Dekker G, Kupferminc M: Pre-eclampsia. Lancet 2005, 365(9461):785-799.
• [3]Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R: Pre-eclampsia. Lancet 2010, 376(9741):631-644.
• [4]Jackson RA, Gibson KA, Wu YW, Croughan MS: Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol 2004, 103(3):551-563.
• [5]Shevell T, Malone FD, Vidaver J, Porter TF, Luthy DA, Comstock CH, Hankins GD, Eddleman K, Dolan S, Dugoff L, et al.: Assisted reproductive technology and pregnancy outcome. Obstet Gynecol 2005, 106(5 Pt 1):1039-1045.
• [6]Chen XK, Wen SW, Bottomley J, Smith GN, Leader A, Walker MC: In vitro fertilization is associated with an increased risk for preeclampsia. Hypertens Pregnancy 2009, 28(1):1-12.
• [7]Thomopoulos C, Tsioufis C, Michalopoulou H, Makris T, Papademetriou V, Stefanadis C: Assisted reproductive technology and pregnancy-related hypertensive complications: a systematic review. J Hum Hypertens 2013, 27(3):148-157.
• [8]Joffe MM, Rosenbaum PR: Invited commentary: propensity scores. Am J Epidemiol 1999, 150(4):327-333.
• [9]Leuven E, Sianesi B. PSMATCH2: Stata module to perform full Mahalanobis and propensity score matching, common support graphing, and covariate imbalance testing. 2003. [ http://ideas.repec.org/c/boc/bocode/s432001.html webcite]
• [10]Guo S, Fraser MW: Propensity Score Analysis. Thausand Oaks, CA: SAGE Publications, Inc; 2010.
• [11]Kallen B, Finnstrom O, Lindam A, Nilsson E, Nygren KG, Otterblad Olausson P: Trends in delivery and neonatal outcome after in vitro fertilization in Sweden: data for 25 years. Hum Reprod 2010, 25(4):1026-1034.
• [12]Gaillard R, Bakker R, Willemsen SP, Hofman A, Steegers EA, Jaddoe VW: Blood pressure tracking during pregnancy and the risk of gestational hypertensive disorders: the generation R study. Eur Heart J 2011, 32(24):3088-3097.
• [13]Macdonald-Wallis C, Tilling K, Fraser A, Nelson SM, Lawlor DA: Established preeclampsia risk factors are related to patterns of blood pressure change in normal term pregnancy: findings from the Avon longitudinal study of parents and children. J Hypertens 2011, 29(9):1703-1711.
• [14]Lain KY, Roberts JM: Contemporary concepts of the pathogenesis and management of preeclampsia. JAMA 2002, 287(24):3183-3186.
• [15]Basso O, Weinberg CR, Baird DD, Wilcox AJ, Olsen J: Subfecundity as a correlate of preeclampsia: a study within the Danish National Birth Cohort. Am J Epidemiol 2003, 157(3):195-202.
• [16]Trogstad L, Magnus P, Moffett A, Stoltenberg C: The effect of recurrent miscarriage and infertility on the risk of pre-eclampsia. BJOG 2009, 116(1):108-113.