Introduction: While Canadian trends demonstrate increasing use of assisted reproductive technologies (ART), these pregnancies have been associated with adverse obstetrical and neonatal outcomes, independent from the risk of delivering multiples. Pregnancies achieved by oocyte donation (OD) may be associated with unique complications when compared to non-OD ART due to greater antigenic dissimilarity. It was hypothesized that a chronic inflammatory response stemming from this maternal-fetal incompatibility would manifest as placental pathologies and adverse clinical outcomes. The objective of this study was to correlate maternal and fetal outcomes with placental pathologies in a Canadian context.
Methods: Data describing maternal health, obstetrical outcomes, neonatal outcomes, and placental pathology were collected and analyzed from The Ottawa Hospital (TOH) electronic database. This retrospective study included patients who achieved pregnancy by OD and non-OD ART and delivered at TOH between 2011 and 2018. Patients without pathology reports or antenatal history were excluded. A total of 356 pregnancies (23% OD) and 553 fetuses (23% OD) were included.
Results: While results demonstrated increased frequency of adverse obstetrical outcomes including preeclampsia, pregnancy induced hypertension, unplanned caesarean-section, and gestational diabetes, they were not statistically significant when adjusted for maternal age, parity, and BMI. Further, there were no demonstrated trends or statistical differences in adverse neonatal outcomes such as Apgar scores, NICU admission, birth weight, preterm birth, sepsis or respiratory disease. Placental pathology data demonstrated increased frequency of fetal vascular malperfusion, maternal vascular malperfusion, and chronic villitis, representing a chronic inflammatory response, in the OD group, however, not statistically significant.
Conclusion: In support of maternal-fetal antigenic incompatibility, clinical trends demonstrate an increased risk of placental pathologies and adverse pregnancy outcomes, with no increased risk for adverse neonatal outcomes, despite lack of statistical significance. It is predicted that this study will have clinical implications and be used to inform patient counselling of oocyte donation pregnancies.
Dina El Demellawy– Pediatric Pathologist, Children's Hospital of Eastern Ontario
Shi Wu Wen– Professor and Senior Scientist, School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Canada
Chloé Rozon– Resident Physician, The Ottawa Hospital
Jennifer Clancy– Research Coordinator, The Ottawa Hospital
Karen Fung Kee Fung– Maternal Fetal Medicine, The Ottawa Hospital