Risk of ischemic placental disease is increased following in vitro fertilization with oocyte donation: a retrospective cohort study

Purpose Assess the risk of ischemic placental disease (IPD) among in vitro fertilization (IVF; donor and autologous) pregnancies compared with non-IVF pregnancies. Methods This was a retrospective cohort study of deliveries from 2000 to 2015 at a tertiary hospital. The exposures, donor, and autologous IVF, were compared with non-IVF pregnancies and donor IVF pregnancies were also compared with autologous IVF pregnancies. The outcome was IPD (preeclampsia, placental abruption, small for gestational age (SGA), or intrauterine fetal demise due to placental insufficiency). We defined SGA as birthweight < 10th percentiles for gestational age and sex. A secondary analysis restricted SGA to < 3rd percentile. Results Of 69,084 deliveries in this cohort, 262 resulted from donor IVF and 3,501 from autologous IVF. Compared with non-IVF pregnancies, IPD was more common among donor IVF pregnancies (risk ratio (RR) = 2.9; 95% CI 2.5-3.4) and autologous IVF pregnancies (RR = 2.0; 95% CI 1.9-2.1), adjusted for age and parity. IVF pregnancies were more likely to be complicated by preeclampsia (donor RR = 3.8; 95% CI 2.8-5.0 and autologous RR = 2.2; 95% CI 2.0-2.5, adjusted for age, parity, and marital status), placental abruption (donor RR = 3.8; 95% CI 2.1-6.7 and autologous RR = 2.5; 95% CI 2.1-3.1, adjusted for age), and SGA (donor RR = 2.7; 95% CI 2.1-3.4 and autologous RR = 2.0; 95% CI 1.9-2.2, adjusted for age and parity). Results were similar when restricting SGA to < 3rd percentile. Conclusion Pregnancies conceived using donor IVF and autologous IVF were at higher risk of IPD and its associated conditions than non-IVF pregnancies and associations were consistently stronger for donor IVF pregnancies.