Maternal Medical Complications in Pregnancy Following Assisted Reproductive Technology

  • Margaret RamsayEmail author
  • Shobhana Parameshwaran


Pregnancies resulting from ART may have increased risks for maternal medical complications, especially gestational hypertension, pre-eclampsia, thromboembolism and gestational diabetes. These risks largely arise due to the characteristics of the women who undergo ART and are most marked in older women, those with high body mass index or polycystic ovary syndrome and in multiple pregnancies; but risks especially for pre-eclampsia are high when donor gametes have been used. Thorough risk assessment is important for each of these complications in early pregnancy, in order to plan surveillance or to institute prophylactic treatment. Women with significant underlying medical conditions need careful assessment prior to commencement of ART protocols to consider maternal and fetal risks in pregnancy, plan appropriate health surveillance during pregnancy and consider adjustment of medication.


Pre-eclampsia Gestational Hypertension Gestational Diabetes Venous thromboembolism Risk assessment Thromboprohylaxis Aspirin Blood pressure Surveillance 


  1. 1.
    Mallizia BA, Hacker MR. Cummulative live birth rates after in vitro fertilization. N Engl J Med. 2009;360:236–43.CrossRefGoogle Scholar
  2. 2.
    Pinborg A, Loft A, Schmidt L, Langhoff-Roos J, Andersen AN. Maternal risks and perinatal outcome in a Danish national cohort of 1005 twin pregnancies: the role of in vitro fertilization. Act Obstet Gynecol Scand. 2004;83:75–84.CrossRefGoogle Scholar
  3. 3.
    Shevell T, Malone FD, Vidaver J, Porter TF, Luthy DA, Comstock CH, et al. Assisted reproductive technology and pregnancy outcome. Obstet Gynecol. 2005;106:1039–45.CrossRefPubMedGoogle Scholar
  4. 4.
    Thomopoulos C, Tsioufis C, Michalopoulou H, Makris T, Papademetriou V, Stefanadis C. Assisted reproductive technology and pregnancy-related hypertensive complications: a systematic review. J Hum Hypertens. 2013;27:148–57.CrossRefPubMedGoogle Scholar
  5. 5.
    Pandey S, Shetty A, Hamilton M, Bhattacharya S, Maheshwari A. Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis. Hum Reprod Update. 2012;18:485–503.CrossRefPubMedGoogle Scholar
  6. 6.
    Farhi A, Reichman B, Boyko V, Hourvitz A, Ron-El R, Lerner-Geva L. Maternal and neonatal health outcomes following assisted reproduction. Reprod Biomed Online. 2013;26:454–61.CrossRefPubMedGoogle Scholar
  7. 7.
    Hayashi M, Nakai A, Satoh S, Matsuda Y. Adverse obstetric and perinatal outcomes of singleton pregnancies may be related to maternal factors associated with infertility rather than the type of assisted reproductive technology procedure used. Fertil Steril. 2012;98:922–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Watanabe N, Fujiwara T, Suzuki T, Jwa SC, Taniguchi K, Yamanobe Y, et al. Is in vitro fertilization associated with preeclampsia? A propensity score matched study. BMC Pregnancy Childbirth. 2014;14:69.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Office for National Statistics. Live births by characteristics of mother. England and Wales, 2010.Google Scholar
  10. 10.
    Jacobsson B, Ladfors L, Milsom I. Advanced maternal age and adverse perinatal outcome. Obstet Gynecol. 2004;104:727–33.CrossRefPubMedGoogle Scholar
  11. 11.
    Cleary-Goldman J, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH, et al. Impact of maternal age on obstetric outcome. Obstet Gynecol. 2005;105:983–90.CrossRefPubMedGoogle Scholar
  12. 12.
    Lao T, Ho L-F, Chan BCP, Leung W-C. Maternal age and prevalence of gestational diabetes mellitus. Diabetes Care. 2006;29:948.CrossRefPubMedGoogle Scholar
  13. 13.
    Toshimitsu M, Nagamatsu T, Nagasaka T, Iwasa-Kawai Y, Komatsu A, Yamashita T, et al. 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. Fertil Steril. 2014;102:1065–70.CrossRefPubMedGoogle Scholar
  14. 14.
    NICE guideline CG 107: Hypertension in pregnancy. 2011.
  15. 15.
  16. 16.
    NICE guideline NG 3: Diabetes in pregnancy. 2015.
  17. 17.
    RCOG. Thrombosis and embolism during pregnancy and the puerperium, reducing the risk (Green-top Guideline No. 37a). 2009.
  18. 18.
    Sibai BM, Hauth J, Caritis S, Lindheimer MD, MacPherson C, Klebanoff M, et al. Hypertensive disorders in twin versus singleton gestations. Am J Obstet Gynecol. 2000;182:938–42.CrossRefPubMedGoogle Scholar
  19. 19.
    Lynch A, McDuffie R, Murphy J, Faber K, Orleans M. Preeclampsia in multiple gestation: the role of assisted reproductive technologies. Obstet Gynecol. 2002;99:445–51.PubMedGoogle Scholar
  20. 20.
    Groeneveld E, Lambers MJ, Lambalk CB, Broeze KA, Hapsamo M, de Sutter P, et al. Preconceptional low-dose aspirin for the prevention of hypertensive pregnancy complications and preterm delivery after IVF: a meta-analysis with patient data. Hum Reprod. 2013;28:1480–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Roos N, Kieleer H, Sahlin L, Ekman-Ordeberg G, Falconer H, Stephansson O. Risk of adverse pregnancy outcomes in women with polycystic ovary syndrome: population based cohort study. BMJ. 2011;343:d6309. doi: 10.1136/bmj.d6309.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Han AR, Kim HO, Cha SW, Park CW, Kim JY, Yang KM, et al. Adverse pregnancy outcomes with assisted reproductive technology in non-obese women with polycystic ovary syndrome: a case-control study. Clin Exp Reprod Med. 2011;38:103–8.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Van den Boogaard E, Vissenberg R, Land JA, van Wely M, van der Post JAM, Goddijn M, Bisschop PH. Significant of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review. Hum Reprod Update. 2011;17:605–19.CrossRefPubMedGoogle Scholar
  24. 24.
    Velkeniers B, Van Meerhaeghe A, Poppe K, Unuane D, Touraye H, Haentjens P. Levothyroxine treatment and pregnancy outcomes in women with subclinical hypothyroidism undergoing assisted reproduction technologies: systematic review and meta-analysis of RCTs. Hum Reprod Update. 2013;19:251–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Chevalier N, Letur H, Lelannou D, Ohl J, Cornet D, Chalas-Boissonnas C, et al. Materno-fetal cardiovascular complications in Turner syndrome after oocyte donation: insufficient prepregnancy screening and pregnancy follow-up are associated with poor outcome. J Clin Endocrinol Metab. 2011;96:E260–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Abe K, Hamada H, Yamad T, Obata-Yasuoka M, Minakami H, Yoshikawa H. Impact of planning a pregnancy in women with epilepsy on seizure control during pregnancy and on maternal and fetal outcomes. Seizure. 2014;23:112–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Scott-Pillai R, Spence D, Cardwell CR, Hunter A, Holmes VA. The impact of body mass index on maternal and neonatal outcomes: a retrospective study in a UK obstetric population, 2004-2011. BJOG. 2013;120:932–9.Google Scholar
  28. 28.
    Fitzsimons KJ, Modder J, Greer IA. Obesity in pregnancy: risks and management. Obstet Med. 2009;2:52–62.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Centre for Maternal and Child Enquiries (CMACE). Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG. 2011;118(Suppl 1):1–203.Google Scholar
  30. 30.
    Cedegren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol. 2004;103:219–24.CrossRefGoogle Scholar
  31. 31.
    Hibbard JU, Gilbert S, Landon MB, Hauth JC, Leveno KJ, Spong CY, et al. Trial of labor or repeat caesarean delivery in women with morbid obesity and previous caesarean delivery. Obstet Gynecol. 2006;108:125–33.CrossRefPubMedGoogle Scholar
  32. 32.
    Maheshwari A, Stofberg L, Bhattacharya S. Effect of overweight and obesity on assisted reproductive technology – a systematic review. Hum Reprod Update. 2007;13:433–44.CrossRefPubMedGoogle Scholar
  33. 33.
    Dokras A, Baredziak L, Blaine J, Syrop C, VanVoorhis BJ, Sparks A. Obstetric outcomes after in vitro fertilization in obese and morbidly obese women. Obstet Gynecol. 2006;108:61–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Luke B, Brown MB, Missmer SA, Bukulmez O, Leach R, Stern JE. The effect of increasing obesity on the response to and outcome of assisted reproductive technology: a national study. Fertil Steril. 2011;96:820–5.CrossRefPubMedGoogle Scholar
  35. 35.
    Brewer CJ, Balen AH. The adverse effects of obesity on conception and implantation. Reproduction. 2010;140:347–64.CrossRefPubMedGoogle Scholar
  36. 36.
    Jungheim ES, Schon SB, Schulte MB, DeUgarte DA, Fowler SA, Tuuli MG. IVF outcomes in obese donor oocyte recipients: a systematic review and meta-analysis. Hum Reprod. 2013;28:2720–7.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Rittenberg V, Seshadri S, Sunkara SK, Sobaleva S, Oteng-Ntim E, El-Toukhy T. Effect of body mass index on IVF treatment outcome: an updated systematic review and meta-analysis. Reprod Biomed Online. 2011;23:421–39.CrossRefPubMedGoogle Scholar
  38. 38.
    NICE guideline CG 156: Fertility: assessment and treatment for people with fertility problems. 2013.
  39. 39.
    Pandey S, Maheshwari A, Bhattacharya S. Should access to fertility treatment be determined by female body mass index? Hum Reprod. 2010;25:815–20.CrossRefPubMedGoogle Scholar
  40. 40.
    Anderson JL, Waller DK, Canfield MA, Shaw GM, Watkins ML, Werler MM. Maternal obesity, gestational diabetes, and central nervous system birth defects. Epidemiology. 2005;16:87–92.CrossRefPubMedGoogle Scholar
  41. 41.
    Khan R, Dawatly B, Chappatte O. Pregnancy outcome following bariatric surgery. Obstet Gynaecol. 2013;15:37–43.CrossRefGoogle Scholar
  42. 42.
    Salha O, Sharma V, Dada T, Nugent D, Rutherford AJ, Tomlinson AJ, et al. The influence of donated gametes on the incidence of hypertensive disorders of pregnancy. Hum Reprod. 1999;14:2268–73.CrossRefPubMedGoogle Scholar
  43. 43.
    Kyrou D, Kolibianakis EM, Devroey P, Fatemi HM. Is the use of donor sperm associated with a higher incidence of pre- eclampsia in women who achieve pregnancy after intrauterine insemination? Fertil Steril. 2010;93:1124–7.CrossRefPubMedGoogle Scholar
  44. 44.
    Krieg SA, Henne MB, Westphal LM. Obstetric outcomes in donor oocyte pregnancies compared with advanced maternal age in vitro fertilization pregnancies. Fertil Steril. 2008;90:65–70.CrossRefPubMedGoogle Scholar
  45. 45.
    Stoop D, Baumgarten M, Haentjens P, Polyzos NP, De Vos M, Verheyen G, et al. Obstetric outcome in donor oocyte pregnancies: a matched pair analysis. Reprod Biol Endocrinol. 2012;10:42.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Fetomaternal Medicine and ObstetricsNottingham University Hospitals, Queen’s Medical Centre CampusNottinghamUK
  2. 2.Department of Obstetrics and GynaecologySheffield Teaching HospitalsSheffieldUK

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