title: Outcomes of spontaneous and assisted pregnancies in Turner syndrome: the U.S. National Institutes of Health experience.
abstract: OBJECTIVE
  To assess fetal and maternal outcomes of pregnancies in women with Turner syndrome (TS).
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Clinical research center.
  
  
  METHODS
  276 adults with cytogenetically proven TS participating in an intramural natural history protocol.
  
  
  METHODS
  None.
  
  
  METHODS
  Menstrual and obstetric histories, 50-cell karyotypes, and cardiovascular evaluation including aortic diameter measurements.
  
  
  RESULTS
  Our cohort included five women with spontaneous pregnancies and five with pregnancies using assisted reproduction (ART). All five women with spontaneous pregnancies had spontaneous puberty, despite 45,X in ≥90% of their 50-cell karyotype. Participants had a total of 13 pregnancies and 14 live births. One child had cerebral palsy; the others were chromosomally and developmentally normal. Delivery was by cesarean section in four out of seven spontaneous and six out of six ART-related pregnancies. One mother experienced preeclampsia in an ART-related twin pregnancy that required a preterm delivery; she has marked but stable aortic dilation years later.
  
  
  CONCLUSIONS
  Approximately 2% of our study cohort experienced spontaneous pregnancies despite high-grade X monosomy, and a similar number achieved pregnancy via oocyte donation and ART. The potential for life-threatening cardiovascular complications warrants comprehensive screening before conception or single-embryo transfer, and caution regarding unintentional pregnancies for TS women.
authors.affiliation: Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-1103, USA.
authors.forename: Tracy N
authors.initials: TN
authors.lastname: Hadnott
authors.forename: Harley N
authors.initials: HN
authors.lastname: Gould
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Gharib
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Bondy
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002547:Cerebral Palsy / Q000235:genetics; D041321:Chromosomes, Human, X; D005260:Female; D005298:Fertility / Q000235:genetics; D006801:Humans; D007621:Karyotyping; D050498:Live Birth; D008875:Middle Aged; D009006:Monosomy; D009316:National Institutes of Health (U.S.); D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000235:genetics; D018873:Pregnancy Rate; D011627:Puberty; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014424:Turner Syndrome / Q000150:complications / Q000235:genetics / Q000503:physiopathology*; D014481:United States; D055815:Young Adult