Levron Yacov, Dviri Michal, Segol Inbar, Yerushalmi Gil M, Hourvitz Ariel, Orvieto Raoul, Mazaki-Tovi Shali, Yinon Yoav
Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Am J Obstet Gynecol. 2014 Oct;211(4):383.e1-5. doi: 10.1016/j.ajog.2014.03.044. Epub 2014 Mar 19.
To determine the prevalence of placental complications in patients conceived through donor versus autologous oocytes.
A retrospective cohort study including 2 groups of patients who conceived through in vitro fertilization using: (1) donor oocyte (n = 139) and (2) autologous oocyte (n = 126). Only singleton gestations were included. The rate of placental complications including preeclampsia, gestational hypertension, and intrauterine growth restriction was compared between these 2 groups.
The women who conceived using donor oocytes were older compared with women who conceived using autologous oocytes (median maternal age 45 vs 41, P < .01). The rate of hypertensive diseases of pregnancy including gestational hypertension and preeclampsia was significantly higher in ovum donor recipients compared with women conceived with autologous oocytes (25% vs 10%, P < .01). Similarly, the rate of intrauterine growth restriction was also higher among patients conceived through oocyte donation although it did not reach statistical significance (9.3% vs 4%, P = .08). When maternal age was restricted to ≤45 years, the rate of hypertensive diseases of pregnancy remained significantly higher among ovum donor compared with autologous oocyte recipients (22% vs 10%, P = .02). Adjustment for maternal age, gravidity, parity, and chronic hypertension revealed that oocyte donation was independently associated with higher rate of hypertensive diseases of pregnancy (P = .01).
Patients conceived through oocyte donation have an increased risk for placental complications of pregnancy. These findings support the 'immunologic theory' suggesting that immunologic intolerance between the mother and the fetus may play an important role in the pathogenesis of preeclampsia.
确定通过供体卵母细胞与自体卵母细胞受孕的患者中胎盘并发症的发生率。
一项回顾性队列研究，纳入两组通过体外受精受孕的患者：（1）供体卵母细胞组（n = 139）和（2）自体卵母细胞组（n = 126）。仅纳入单胎妊娠。比较这两组之间包括子痫前期、妊娠高血压和胎儿生长受限在内的胎盘并发症发生率。
与使用自体卵母细胞受孕的女性相比，使用供体卵母细胞受孕的女性年龄更大（母亲年龄中位数45岁对41岁，P <.01）。与使用自体卵母细胞受孕的女性相比，接受卵母细胞捐赠者中包括妊娠高血压和子痫前期在内的妊娠高血压疾病发生率显著更高（25%对10%，P <.01）。同样，通过卵母细胞捐赠受孕的患者中胎儿生长受限的发生率也更高，尽管未达到统计学显著性（9.3%对4%，P =.08）。当母亲年龄限制在≤45岁时，接受卵母细胞捐赠者中妊娠高血压疾病的发生率仍然显著高于自体卵母细胞接受者（22%对10%，P =.02）。对母亲年龄、孕次、产次和慢性高血压进行调整后发现，卵母细胞捐赠与妊娠高血压疾病的较高发生率独立相关（P =.01）。
通过卵母细胞捐赠受孕的患者发生妊娠胎盘并发症的风险增加。这些发现支持“免疫理论”，表明母亲与胎儿之间的免疫不耐受可能在子痫前期的发病机制中起重要作用。
