title: Materno-fetal cardiovascular complications in Turner syndrome after oocyte donation: insufficient prepregnancy screening and pregnancy follow-up are associated with poor outcome.
abstract: BACKGROUND
  Recombinant human GH treatment and oocyte donation (OD) have improved the quality of life in women with Turner syndrome (TS). However, life expectancy is reduced, mainly due to cardiovascular complications. Pregnancy may itself increase that risk and be associated with hazardous materno-fetal outcome.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the materno-fetal outcome of ongoing pregnancies beyond 20 wk of gestation obtained by OD in TS.
  
  
  METHODS
  This was a multicenter retrospective study including all assisted reproductive technology centers affiliated with the French Study Group for Oocyte Donation.
  
  
  RESULTS
  Among 93 patients, only 37.6% were prescreened with echocardiography or thoracic magnetic resonance imaging. Maternal outcome was dominated by 37.8% of pregnancy-associated hypertensive disorders including preeclampsia in 54.8% and severe eclampsia in four patients. Prematurity occurred in 38.3% and was correlated with pregnancy-associated hypertensive disorder (P = 0.01). The frequency of in utero growth retardation was 27.5%. One fetal demise was linked to eclampsia. Two patients died from aortic rupture after cesarean section in a context of aortic root dilatation. Only 40% of pregnancies were associated with an absolutely normal materno-fetal outcome.
  
  
  CONCLUSIONS
  OD pregnancies in TS who have not been managed following recent specific recommendations were at high risk for maternal death by aortic dissection and for preeclampsia and its complications (fetal distress and in utero growth retardation). These recommendations include previous echocardiography, thoracic magnetic resonance imaging, and overnight blood pressure monitoring associated with a tight follow-up during pregnancy. Until future assessment of these recent recommendations, pregnancies obtained in TS after OD must be still considered as very high-risk pregnancies.
authors.affiliation: Department of Endocrinology and Reproductive Medicine, Centre Hospitalier Universitaire de Nice and Institut National de la Santé et de la Recherche Médicale Unité 895/C3M, 06202 Nice, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Chevalier
authors.forename: Hélène
authors.initials: H
authors.lastname: Letur
authors.forename: Dominique
authors.initials: D
authors.lastname: Lelannou
authors.forename: Jeanine
authors.initials: J
authors.lastname: Ohl
authors.forename: Dominique
authors.initials: D
authors.lastname: Cornet
authors.forename: Cécile
authors.initials: C
authors.lastname: Chalas-Boissonnas
authors.forename: René
authors.initials: R
authors.lastname: Frydman
authors.forename: Sophie
authors.initials: S
authors.lastname: Catteau-Jonard
authors.forename: Thérèse
authors.initials: T
authors.lastname: Greck-Chassain
authors.forename: Aline
authors.initials: A
authors.lastname: Papaxanthos-Roche
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Dulucq
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Couet
authors.forename: Isabelle
authors.initials: I
authors.lastname: Cédrin-Durnerin
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Pouly
authors.forename: Patrick
authors.initials: P
authors.lastname: Fénichel
mesh_terms: D000328:Adult; D001724:Birth Weight; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D007236:Infant, Small for Gestational Age; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D018587:Oocyte Donation; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D011295:Prenatal Care; D012189:Retrospective Studies; D017211:Treatment Failure; D014424:Turner Syndrome / Q000150:complications* / Q000000981:diagnostic imaging; D014463:Ultrasonography