Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada.
Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON K1N 7K4, Canada.
Placenta. 2021 May;108:114-121. doi: 10.1016/j.placenta.2021.03.012. Epub 2021 Mar 23.
Assisted reproductive technology including in vitro fertilization (IVF) and oocyte donation (OD) may increase risk for placenta-mediated diseases. Comprehensive analysis of histopathological placental lesions according to source of oocytes used in the IVF procedure - recipient derived (RD-IVF) vs oocyte donation (OD-IVF), has not been conducted in a population with a hypertensive disorder of pregnancy (HDP) and/or intrauterine growth restriction (IUGR).
A retrospective cohort study of archived placenta specimens from RD-IVF and OD-IVF pregnancies affected by HDP and/or IUGR was conducted with blinded histopathological placental examination. Three categories of lesions were differentiated and defined as main outcomes: maternal vascular malperfusion (MVM), chronic inflammation, and fetal vascular malperfusion (FVM). To determine the relationship between conception method and placental lesions, multivariable regressions were performed with maternal age, gestational age, HDP, birth and placental weight percentiles as model covariates.
115 placentas were included 83 (72.2%) RD-IVF, 32 (27.8%) OD-IVF. Adjusted OR (aOR) for conception method was 5.05 (95%CI 0.58-43.90, p=0.142) for MVM, 1.87 (95%CI 0.68-5.15, p=0.228) for chronic inflammatory and 0.61 (95%CI 0.15-2.37, p=0.471) for FVM lesions. Multiple gestation demonstrated borderline association with MVM (aOR=0.24, 95%CI 0.04-1.51, p=0.129) and total pathology score (aRR=0.79, 95%CI 0.62-1.01, p=0.058). Subgroup analysis suggested greater odds of villitis of unknown etiology (VUE) for OD-IVF (aOR=2.98, 95%CI 1.12-7.93, p=0.029).
Source of oocyte derivation demonstrated no evidence of association with main outcomes in cases of HDP and/or IUGR. Subgroup analysis demonstrated increased rates of inflammatory lesions for OD-IVF. Multiple gestation may be associated with decreased MVM and total lesions.
辅助生殖技术（包括体外受精[IVF]和卵母细胞捐赠[OD]）可能会增加胎盘介导疾病的风险。根据体外受精过程中使用的卵母细胞来源（受体来源[RD-IVF]与卵母细胞捐赠[OD-IVF]）对胎盘组织病理学病变进行综合分析，尚未在患有妊娠高血压疾病（HDP）和/或宫内生长受限（IUGR）的人群中进行过。
对 HDP 和/或 IUGR 受影响的 RD-IVF 和 OD-IVF 妊娠的存档胎盘标本进行回顾性队列研究，并进行盲法胎盘组织病理学检查。将三种病变类型区分并定义为主要结局：母体血管灌注不良（MVM）、慢性炎症和胎儿血管灌注不良（FVM）。为了确定受孕方法与胎盘病变之间的关系，使用产妇年龄、孕龄、HDP、出生和胎盘体重百分位数作为模型协变量进行多变量回归。
纳入 115 例胎盘，其中 83 例（72.2%）为 RD-IVF，32 例（27.8%）为 OD-IVF。受孕方法的调整比值比（aOR）为 MVM 5.05（95%CI 0.58-43.90，p=0.142），慢性炎症 1.87（95%CI 0.68-5.15，p=0.228），FVM 病变 0.61（95%CI 0.15-2.37，p=0.471）。多胎妊娠与 MVM（aOR=0.24，95%CI 0.04-1.51，p=0.129）和总病理评分（aRR=0.79，95%CI 0.62-1.01，p=0.058）呈边缘关联。亚组分析表明，OD-IVF 的不明病因绒毛膜炎（VUE）发生几率更高（aOR=2.98，95%CI 1.12-7.93，p=0.029）。
卵母细胞来源与 HDP 和/或 IUGR 病例的主要结局无关联证据。亚组分析显示，OD-IVF 的炎症病变发生率增加。多胎妊娠可能与 MVM 和总病变减少有关。
