title: The 'immunologic theory' of preeclampsia revisited: a lesson from donor oocyte gestations.
abstract: OBJECTIVE
  To determine the prevalence of placental complications in patients conceived through donor versus autologous oocytes.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yacov
authors.initials: Y
authors.lastname: Levron
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Dviri
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Inbar
authors.initials: I
authors.lastname: Segol
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Gil M
authors.initials: GM
authors.lastname: Yerushalmi
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Hourvitz
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Raoul
authors.initials: R
authors.lastname: Orvieto
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Shali
authors.initials: S
authors.lastname: Mazaki-Tovi
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Yinon
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects* / Q000379:methods; D005317:Fetal Growth Retardation / Q000453:epidemiology / Q000209:etiology / Q000276:immunology*; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology / Q000209:etiology / Q000276:immunology; D008875:Middle Aged; D018587:Oocyte Donation / Q000009:adverse effects*; D017063:Outcome Assessment, Health Care; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000209:etiology / Q000276:immunology*; D011247:Pregnancy; D015995:Prevalence; D012189:Retrospective Studies
keywords: donor oocyte; obstetric outcome; preeclampsia; pregnancy induced hypertension