Very early premature birth and isthmic-cervical insufficiency in pregnancy resulting from assisted reproductive technologies

Malgina G.B., Fassakhova A.F., Tretyakova T.B., Brusnitsyna V.Yu., Rykosuev N.E.

Ural Research Institute of Maternal and Infant Care, Ministry of Health of Russia, Yekaterinburg 620028, Repin str. 1, Russia
Objective. To identify risk factors for very early premature birth (VEPB) and isthmic-cervical insufficiency (ICI) in pregnancy resulting from assisted reproductive technologies (ART).
Subjects and methods. Step 1 was to retrospectively assess perinatal outcomes in 483 pregnant women after ART and in 645 patients with natural conception. Step 2 was to conduct a case-control study. A study group included 76 pregnant women after ART with ICI: 33 and 43 women had singleton and multiple pregnancies, respectively. A control group consisted of 67 pregnant women after ART with no ICI: 37 and 30 women with singleton and multiple pregnancies, respectively.
Results. Odds ratio (OR) for ICI after ART was 5.5 with 95% CI, 3.6-8.4; p < 0.05. OR for VEPB after ART was 3.3 with 95% CI, 1.4 to 8.1; p< 0.05. ICI in VEPB was detected in 75.6%. The risk factors for ICI after ART are 3 or more attempts of the latter, the lack of long-term hormonal support and cervicometry. In singleton pregnancy, the additional risk factors are a history of early miscarriages, as well as endocrinopathy.
Conclusion. Cervicometry and prolonged progestin support are recommended for the prevention of ICI during pregnancy after ART.

Keywords

assisted reproductive technologies
very early premature birth
isthmic-cervical insufficiency
risk factors

References

1. Регистр ВРТ РАРЧ. Доступно по: http://www.rahr.ru/d_registr_otchet/Otchet_za-2009_pages.pdf Ссылка активна на: 05.02.2017 г. [The Russian Association of Human Reproduction. Register of VRT centers in Russia. Report for the year 2009. Available at: http://www.rahr.ru/d_registr_otchet/Otchet_za-2009_pages.pdf Accessed 05.02.2017. (in Russian)]

2. Регистр ВРТ РАРЧ. Доступно по: http://www.rahr.ru/d_registr_otchet/registr_BRT_RARCH16.pdf Ссылка активна на: 05.02.2017. [The Russian Association of Human Reproduction. Register of VRT centers in Russia. Report for the year 2014. Available at: http://www.rahr.ru/d_registr_otchet/registr_BRT_RARCH16.pdf Accessed 05.02.2017. (in Russian)].

3. Caserta D., Bordi G., Stegagno M., Filippini F., Podagrosi M., Roselli D., Moscarini M. Maternal and perinatal outcomes in spontaneous versus assisted conception twin pregnancies. Eur. J. Obstet. Gynecol. Reprod. Biol. 2014; 174: 64-9. doi: 10.1016/j.ejogrb.2013.12.011.

4. Hayashi M., Nakai A., Satoh S., Matsuda Y. Adverse obstetric and perinatal outcomes of singleton pregnancies may be related to maternal factors associated with infertility rather than the type of assisted reproductive technology procedure used. Fertil. Steril. 2012; 98(4): 922-8. doi: 10.1016/j.fertnstert.2012.05.049.

5. Zhu L., Zhang Y., Liu Y., Zhang R., Wu Y., Huang Y. et al. Maternal and live-birth outcomes of pregnancies following assisted reproductive technology: a retrospective cohort study. Sci. Rep. 2016; 6: 35141. doi: 10.1038/srep35141.

6. Kulkarni A.D., Kissin D.M., Adashi E.Y. Fertility treatments and multiple births in the United States. N. Engl. J. Med. 2014; 370(11): 1070-1. doi: 10.1056/NEJMc1400242.

7. Saccone G., Zullo F., Roman A., Ward A., Maruotti G., Martinelli P., Berghella V. Risk of spontaneous preterm birth in IVF-conceived twin pregnancies. J. Matern. Fetal Neonatal Med. 2017; Sep 21: 1-8. doi: 10.1080/14767058.2017.1378339.

8. Blencowe H., Cousens S., Oestergaard M.Z., Chou D., Moller A.B., Narwal R. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012; 379(9832): 2162-72. doi: 10.1016/S0140-6736(12)60820-4.

9. Parets S.E., Knight A.K., Smith A.K. Insights into genetic susceptibility in the etiology of spontaneous preterm birth. Appl. Clin. Genet. 2015; 8: 283-90. doi: 10.2147/TACG.S58612.

10. Iams J.D., Cebrik D., Lynch C., Behrendt N., Das A. The rate of cervical change and the phenotype of spontaneous preterm birth. Am. J. Obstet. Gynecol. 2011; 205(2): 130. e1-6. doi: 10.1016/j.ajog.2011.05.021.

11. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency. Obstet. Gynecol. 2014; 123(2, Pt 1): 372-9. doi: 10.1097/01.AOG.0000443276.68274.cc.

12. Alfirevic Z., Stampalija T., Roberts D., Jorgensen A.L. Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database Syst. Rev. 2012; (4): CD008991. doi: 10.1002/14651858.CD008991.

13. Kanninen TT, Sisti G, Ramer I, Goldschlag D, Witkin SS, Spandorfer SD. Predictive biomarkers of preterm delivery in women with ongoing IVF pregnancies. J. Reprod. Immunol. 2015; 112: 58-62. doi: 10.1016/j.jri.2015.05.004.

14. Vrachnis N., Grigoriadis C., Siristatidis C., Vlachadis N., Balakitsas N., Mastorakos G., Iliodromiti Z. The Janus face of maternal serum relaxin: a facilitator of birth, might it also induce preterm birth? J. Matern. Fetal Neonatal Med. 2015; 28(18): 2187-91. doi: 10.3109/14767058.2014.981804.

15. Mak W., Kondapalli L.A., Celia G., Gordon J., DiMattina M., Payson M. Natural cycle IVF reduces the risk of low birthweight nfants compared with conventional stimulated IVF. Hum. Reprod. 2016; 31(4): 789-94. doi: 10.1093/humrep/dew024.

16. Kawwass J.F., Kulkarni A.D., Hipp H.S., Crawford S., Kissin D.M., Jamieson D.J. Extremities of body mass index and their association with pregnancy outcomes in women undergoing in vitro fertilization in the United States. Fertil. Steril. 2016; 106(7): 1742-50. doi: 10.1016/j.fertnstert.2016.08.028.

Received 01.09.2017

Accepted 22.09.2017

About the Authors

Malgina Galina B., Professor, Head of Science of Ural Research Institute of Maternal and Infant Care, Ministry of Health of Russia.
620028, Yekaterinburg, Repin str. 1. Tel.: +73433710878. E-mail: galinamalgina@mail.ru. ORCID ID 0000-0002-5500-6296
Fassakhova Aigul F., Junior Researcher, Scientific Department of Antenatal Fetal Care, Ural Research Institute of Maternal and Infant Care, Ministry of Health of Russia. 620028, Yekaterinburg, Repin str. 1. Tel.: +73433710878
Tretyakova Tatyana B., PhD, Senior Researcher, Scientific Department of Biochemistry with Genetics Group, Ural Research Institute of Maternal and Infant Care,
Ministry of Health of Russia. 620028, Yekaterinburg, Repin str. 1. Tel.: +73433710878
BrusnitsinaVera Ju, Senior Researcher, Scientific Department of the Preservation of Reproductive Function, Ural Research Institute of Maternal and Infant Care,
Ministry of Health of Russia. 620028, Yekaterinburg, Repin str. 1. Tel.: +73433710878
Roukosouev Nikita Ye., Junior Researcher, Scientific Department of Biochemistry with Genetics Group, Ural Research Institute of Maternal and Infant Care,
Ministry of Health of Russia. 620028, Yekaterinburg, Repin str. 1. Tel.: +73433710878

For citations: Malgina G.B., Fassakhova A.F., Tretyakova T.B.,
Brusnitsyna V.Yu., Rykosuev N.E. Very early premature birth and isthmic-cervical insufficiency
in pregnancy resulting from assisted reproductive technologies.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (5): 44-9. (in Russian)
https://dx.doi.org/10.18565/aig.2018.5.44-49

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