title: Increased risk of pregnancy-induced hypertension and operative delivery after conception induced by in vitro fertilization/intracytoplasmic sperm injection in women aged 40 years and older.
abstract: OBJECTIVE
  To clarify the association between preconception fertility status and obstetric outcomes in women aged 40 years and older.
  
  
  METHODS
  Retrospective study by reviewing medical records.
  
  
  METHODS
  Tertiary perinatal center in a university hospital.
  
  
  METHODS
  330 women aged 40 years and older who delivered a singleton from 2006 to 2010, and 450 women aged 30 to 34 years who delivered at the same facility as controls.
  
  
  METHODS
  None.
  
  
  METHODS
  Incidence of pregnancy-induced hypertension, gestational diabetes mellitus, preterm birth, low birth weight, and mode of delivery assessed based on the mode of conception; spontaneous conception (SC) and in vitro fertilization/intracytoplasmic sperm injection conception (IVF-ICSI).
  
  
  RESULTS
  The incidence of pregnancy-induced hypertension was statistically significantly higher in IVF-ICSI group than the SC group. This gap was commonly observed in both the women aged 40 years and older and those in the 30 to 34 age group. No statistically significant difference was observed in the frequency of gestational diabetes mellitus, preterm birth, or low birth weight. As a characteristic of nulliparous women of advanced age, the rate of operative delivery, which includes emergency cesarean section and instrumental delivery, was statistically significantly higher in IVF-ICSI group than in the SC group. Detailed investigation into the medical indications for operative delivery revealed that the difference was attributable to the elevated incidence of labor protraction and arrest.
  
  
  CONCLUSIONS
  Preconception fertility status can be a predicting factor of the incidence of pregnancy-induced hypertension and labor outcome, especially for women aged 40 years and older.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Masatake
authors.initials: M
authors.lastname: Toshimitsu
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan. Electronic address: tnag-tky@umin.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagamatsu
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Nagasaka
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Iwasawa-Kawai
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Komatsu
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamashita
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Osuga
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujii
mesh_terms: D000328:Adult; D002585:Cesarean Section; D004630:Emergencies; D005113:Extraction, Obstetrical; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro / Q000009:adverse effects*; D006785:Hospitals, University; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis / Q000453:epidemiology*; D015994:Incidence; D007247:Infertility, Female / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D007564:Japan; D008423:Maternal Age; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D020554:Sperm Injections, Intracytoplasmic / Q000009:adverse effects*; D062606:Tertiary Care Centers
keywords: Advanced maternal age; assisted reproduction technology; labor abnormality; preconception fertility status; pregnancy-induced hypertension