title: Adverse obstetric outcomes in pregnancies resulting from oocyte donation: a retrospective cohort case study in Sweden.
abstract: BACKGROUND
  Oocyte donation has been associated to gestational diabetes, hypertensive disorders, placental abnormalities, preterm delivery and increased rate of caesarean delivery while simultaneously being characterized by high rates of primiparity, advanced maternal age and multiple gestation constituting the individual risk of mode of conception difficult to assess. This study aims to explore obstetrical outcomes among relatively young women with optimal health status conceiving singletons with donated versus autologous oocytes (via IVF and spontaneously).
  
  
  METHODS
  National retrospective cohort case study involving 76 women conceiving with donated oocytes, 150 nulliparous women without infertility conceiving spontaneously and 63 women conceiving after non-donor IVF. Data on obstetric outcomes were retrieved from the National Birth Medical Register and the medical records of oocyte recipients from the treating University Hospitals of Sweden. Demographic and logistic regression analysis were performed to examine the association of mode of conception and obstetric outcomes.
  
  
  RESULTS
  Women conceiving with donated oocytes (OD) had a higher risk of hypertensive disorders [adjusted Odds Ratio (aOR) 2.84, 95% CI (1.04-7.81)], oligohydramnios [aOR 12.74, 95% CI (1.24-130.49)], postpartum hemorrhage [aOR 7.11, 95% CI (2.02-24.97)] and retained placenta [aOR 6.71, 95% CI (1.58-28.40)] when compared to women who conceived spontaneously, after adjusting for relevant covariates. Similar trends, though not statistically significant, were noted when comparing OD pregnant women to women who had undergone non-donor IVF. Caesarean delivery [aOR 2.95, 95% CI (1.52-5.71); aOR 5.20, 95% CI (2.21-12.22)] and induction of labor [aOR 3.00, 95% CI (1.39-6.44); aOR 2.80, 95% CI (1.10-7.08)] occurred more frequently in the OD group, compared to the group conceiving spontaneously and through IVF respectively. No differences in gestational length were noted between the groups. With regard to the indication of OD treatment, higher intervention was observed in women with diminished ovarian reserve but the risk for hypertensive disorders did not differ after adjustment.
  
  
  CONCLUSIONS
  The selection process of recipients for medically indicated oocyte donation treatment in Sweden seems to be effective in excluding women with severe comorbidities. Nevertheless, oocyte recipients-despite being relatively young and of optimal health status- need careful counseling preconceptionally and closer monitoring prenatally for the development of hypertensive disorders.
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala University Hospital, Uppsala, SE-751 83, Sweden. evangelia.elenis@kbh.uu.se.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Elenis
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala University Hospital, Uppsala, SE-751 83, Sweden.
authors.forename: Agneta Skoog
authors.initials: AS
authors.lastname: Svanberg
authors.affiliation: Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Solna, Sweden.
authors.forename: Claudia
authors.initials: C
authors.lastname: Lampic
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala University Hospital, Uppsala, SE-751 83, Sweden.
authors.forename: Alkistis
authors.initials: A
authors.lastname: Skalkidou
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala University Hospital, Uppsala, SE-751 83, Sweden.
authors.forename: Helena
authors.initials: H
authors.lastname: Åkerud
authors.affiliation: Obstetrics and Gynaecology, Department of Clinical Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Sydsjö
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D007751:Labor, Induced / Q000706:statistics & numerical data; D016104:Oligohydramnios / Q000453:epidemiology; D018587:Oocyte Donation / Q000009:adverse effects* / Q000706:statistics & numerical data; D018457:Placenta, Retained / Q000453:epidemiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult