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Hypertension. 2019 Mar;73(3):640-649. doi: 10.1161/HYPERTENSIONAHA.118.12043.

Increased Preeclampsia Risk and Reduced Aortic Compliance With In Vitro Fertilization Cycles in the Absence of a Corpus Luteum.

Author information

1
From the Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology (F.v.V.-H., R.R.F., W.Z., V.L.B.), Stanford University School of Medicine, Sunnyvale, CA.
2
Department of Obstetrics and Gynecology, Hannover Medical School, Lower Saxony, Germany (F.v.V.-H.), University of Florida, Gainesville.
3
Department of Obstetrics and Gynecology (A.M.S., R.S.W., A.R.-V., K.P.C.), University of Florida, Gainesville.
4
Department of Biostatistics (Y.-Y.C., K.-H.C., J.L.), University of Florida, Gainesville.
5
Division of Nephrology, Hypertension, and Renal Transplantation (M.L., M.S.S.), University of Florida, Gainesville.
6
Division of Cardiology (W.W.N.), University of Florida, Gainesville.
7
Division of Reproductive, Stem Cell, and Perinatal Biology, Department of Obstetrics and Gynecology (V.D.W.), Stanford University School of Medicine, Sunnyvale, CA.
8
Department of Medicine, and Department of Physiology and Functional Genomics, D.H. Barron Reproductive and Perinatal Biology Research Program (K.P.C.), University of Florida, Gainesville.

Abstract

In vitro fertilization involving frozen embryo transfer and donor oocytes increases preeclampsia risk. These in vitro fertilization protocols typically yield pregnancies without a corpus luteum (CL), which secretes vasoactive hormones. We investigated whether in vitro fertilization pregnancies without a CL disrupt maternal circulatory adaptations and increase preeclampsia risk. Women with 0 (n=26), 1 (n=23), or >1 (n=22) CL were serially evaluated before, during, and after pregnancy. Because increasing arterial compliance is a major physiological adaptation in pregnancy, we assessed carotid-femoral pulse wave velocity and transit time. In a parallel prospective cohort study, obstetric outcomes for singleton livebirths achieved with autologous oocytes were compared between groups by CL number (n=683). The expected decline in carotid-femoral pulse wave velocity and rise in carotid-femoral transit time during the first trimester were attenuated in the 0-CL compared with combined single/multiple-CL cohorts, which were similar (group-time interaction: P=0.06 and 0.03, respectively). The blunted changes of carotid-femoral pulse wave velocity and carotid-femoral transit time from prepregnancy in the 0-CL cohort were most striking at 10 to 12 weeks of gestation ( P=0.01 and 0.006, respectively, versus 1 and >1 CL). Zero CL was predictive of preeclampsia (adjusted odds ratio, 2.73; 95% CI, 1.14-6.49) and preeclampsia with severe features (6.45; 95% CI, 1.94-25.09) compared with 1 CL. Programmed frozen embryo transfer cycles (0 CL) were associated with higher rates of preeclampsia (12.8% versus 3.9%; P=0.02) and preeclampsia with severe features (9.6% versus 0.8%; P=0.002) compared with modified natural frozen embryo transfer cycles (1 CL). In common in vitro fertilization protocols, absence of the CL perturbed the maternal circulation in early pregnancy and increased the incidence of preeclampsia.

KEYWORDS:

hormones; humans; pregnancy; pulse wave analysis; relaxin

PMID:
30636552
PMCID:
PMC6434532
[Available on 2020-03-01]
DOI:
10.1161/HYPERTENSIONAHA.118.12043
[Indexed for MEDLINE]

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