Obstetric and neonatal complications in pregnancies conceived after oocyte donation: a systematic review and meta-analysis.
BACKGROUND
Approximately 50 000 oocyte donation (OD) treatment cycles are now performed annually in Europe and the US.


OBJECTIVE
To ascertain whether the risk of adverse obstetric and perinatal/neonatal outcomes is higher in pregnancies conceived by OD than in pregnancies conceived by conventional in-vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) or spontaneously.


METHODS
A systematic search was performed in the PubMed, Cochrane and Embase databases from 1982-2016. Primary outcomes were hypertensive disorders of pregnancy, pre-eclampsia (PE), gestational diabetes mellitus, postpartum haemorrhage, caesarean section, preterm birth, low birthweight and small for gestational age.


METHODS
Inclusion criteria were original studies including at least five OD pregnancies with a control group of pregnancies conceived by conventional IVF/ICSI or spontaneous conception, and case series with >500 cases reporting one or more of the selected complications. Studies not adjusting for plurality were excluded.


METHODS
Thirty-five studies met the inclusion criteria. A random-effects model was used for the meta-analyses.


RESULTS
For OD pregnancies versus conventional IVF/ICSI pregnancies the risk of PE was adjusted odds ratio (AOR) 2.11 (95% CI, 1.42-3.15) in singleton and AOR 3.31 (95% CI, 1.61-6.80) in multiple pregnancies. The risks of preterm birth and low birthweight in singletons were AOR 1.75 (95% CI, 1.39-2.20) and 1.53 (95% CI, 1.16-2.01), respectively.


CONCLUSIONS
OD conceptions are associated with adverse obstetric and neonatal outcomes. To avoid the additional increase in risk from multiplicity, single-embryo transfer should be the choice of option in OD cycles.


CONCLUSIONS
Oocyte donation pregnancies have increased risk of a range of obstetric and neonatal complications.
Fertility Clinic, Copenhagen University Hospital, Hvidovre Hospital, Copenhagen, Denmark.
M
M
Storgaard
Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
A
A
Loft
Reproductive Medicine, Departments of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden.
C
C
Bergh
Departments of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital/East, Gothenburg, Sweden.
U B
UB
Wennerholm
Väestöliitto Fertility Clinic, Helsinki, Finland.
V
V
Söderström-Anttila
Department of Obstetrics and Gynaecology, IVF Unit, St Olav's University Hospital, Trondheim, Norway.|Department of Public Health, Norwegian University of Science and Technology, Trondheim, Norway.
L B
LB
Romundstad
Department of Medical Genetics, Helsinki University Central Hospital (HUCH) and University of Helsinki, Helsinki, Finland.
K
K
Aittomaki
Section for Reproductive Medicine, Department of Gynecology, Oslo University Hospital, Oslo, Norway.
N
N
Oldereid
Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
J
J
Forman
Fertility Clinic, Copenhagen University Hospital, Hvidovre, Denmark.
A
A
Pinborg
D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects; D006801:Humans; D007231:Infant, Newborn; D018587:Oocyte Donation / Q000009:adverse effects*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology; D011256:Pregnancy Outcome / Q000453:epidemiology*
Caesarean section; low birthweight; oocyte donation; pre-eclampsia; preterm birth