[Medscape] Is IVF associated with a higher risk of gestational diabetes?


BARCELONA — Mothers undergoing assisted reproductive technology are more likely to develop gestational diabetes than mothers who conceived naturally, according to a new meta-analysis presented at the 2019 Annual Meeting. of the European Association for the Study of Diabetes (EASD).

Specifically, the analysis found that women who became pregnant through assisted reproductive technology (ART) were 53 percent more likely to develop gestational diabetes than those who conceived naturally.

Panagiotis Anagnostis, a clinician and researcher from the Aristotle University of Thessaloniki, Greece, who presented the results in posters and in a press conference said: “A rigorous review of the available evidence The best to date suggests that single-child pregnancies using in vitro fertilization (IVF) are associated with an increased risk of developing gestational diabetes compared with pregnancies that are carried out. natural conception”.

He emphasizes that the findings highlight the importance of early detection of gestational diabetes in pregnant women after ART, as well as IVF, including those conceived through intracytoplasmic sperm injection. ICSI).

“This could lead to prompt and effective interventions, especially for women who already have risk factors for gestational diabetes including ovarian syndrome,” says Anagnostis. polycystic kidney disease (PCOS), obesity, increased maternal age, and family history of type 2 diabetes.

“These women should receive intensive lifestyle interventions during IVF and the first trimester of pregnancy as it will reduce the risk of developing gestational diabetes,” he notes.

Adrian Heald, doctor, from the University of Manchester, UK, commented: “This is very serious for us in the work of assisted conception.”

He continued: “Do you feel any long-term consequences … because we know from UK data that if we look at 10 to 15 years with gestational diabetes, about 30% of women develop type 2 diabetes.”

Is the ART team “another group, what do you think?” Heald wondered. Anagnostis replied that it is not currently known. “Long-term prospective data on these women, looking at 10 to 20 years after pregnancy, are needed to shed light on this issue.”

Large studies allow for accurate risk estimates

Estimates suggest that more than half a million babies are born from IVF and ICSI each year. Pregnancy on ART is known to increase the risk of obstetric and perinatal complications, but any potential association with gestational diabetes remains unclear, with previous studies showing results. contradictory, Anagnostis explains.

To address this uncertainty, the endocrinologist and his colleagues conducted a systematic review to determine whether singleton pregnancies after ART (IVF or ICSI) were associated with a higher risk of gestational diabetes compared with normal pregnancies.

The studies were published between 1995 and July 2019, but any cases involving women with PCOS or a history of multiple pregnancies were excluded because these conditions were known to be associated increased risk of gestational diabetes.

A total of 38 cross-sectional studies (17 comparative and 21 noncomparative studies), of which 13 were prospective and 25 retrospective.

Combined, the studies involved nearly 2 million women, of whom more than 163,000 were diagnosed with gestational diabetes.

The diagnosis of gestational diabetes was made in 4776 out of 63,760 women who became pregnant on ART and 158,526 out of 1,870,734 women who conceived spontaneously.

“This number of women allows for an accurate risk estimate of this association,” Anagnostis commented.

“We found that women on ART had a higher risk of developing gestational diabetes, with a relative risk of 1.53 [CI 95%, 1,39 – 1,69].”

“When the subgroup analyzes were performed with comparative and noncomparative studies, we also found similar results,” he reports.

Specifically, a further analysis of 17 studies in which women were matched for age, height, weight, smoking status, and ethnic origin found that women on ART were at increased risk of developing diabetes. gestational diabetes was 40% higher than natural conception, with a relative risk of 1.42 (95% CI, 1.17–1.72).

The corresponding figure for non-comparative studies was 1.58 (95% CI, 1.40–1.78).

The exact mechanism for the association is unclear

However, endocrinologists say the exact mechanism of involvement remains unclear.

“Whether the observed association between ART and gestational diabetes is explained by the presence of infertility or the ART procedure performed, cannot yet be evaluated,” he stressed.

But he said: “The use of progesterone during the luteal phase and first trimester may increase the risk of gestational diabetes because progesterone is known to increase insulin resistance.”

“Also, vitamin D deficiency may be a common underlying cause as it is associated with infertility and gestational diabetes,” he added.

Anagnostis and Heald reported no related financial relationship.

EASD Annual Meeting 2019 Shown September 17, 2019. Poster 921.

Source: IVF Associated With Higher Risk of Gestational Diabetes

Link: https://www.medscape.com/viewarticle/918899#vp_2

The article is translated and edited by ykhoa.org – please do not reup without permission!

Translated by: Thu Vo

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