Is the occurrence of Gestational Diabetes Mellitus in pregnancies higher following In Vitro Fertilization treatment? Why? A retrospective cohort study

Abstract

Purpose: This study aim to determine the occurrence of gestational diabetes mellitus (GDM) in pregnancies after IVF treatment and to evaluate the factors that reduce this risk. Material and Methods: This retrospective cohort study was conducted using the medical records of pregnant women who conceived following IVF at the in-vitro fertilization center between 2002–2019. The data were obtained from medical records and phone interviews. Univariate and multivariate logistic regression analyses were performed. Results: The incidence of GDM was found to be 16.7%. The regression model indicated that the risk of GDM was 4.57 times higher in the age group 36–40 at conception during the IVF cycle than the age group 31–35 (95% CI = 1.18–17.73, p = .028). Furthermore, women who conceived after the second IVF trial had a risk of GDM 3.464 times higher than those that conceived after their first IVF trial (95% CI = 1.07–11.23, p= .038). Conclusion: As age and number of IVF trials increase in infertile women, the risk of GDM increases after IVF treatment.

Keywords

• Gestational Diabetes Mellitus
• In Vitro Fertilization
• Risk Factors

References

1. McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational diabetes mellitus. Nature Reviews Disease Primers 2019;5:47.
2. International Diabetes Federation (IDF) Diabetes Atlas. 10th Edition. ISBN: 978-2-930229-98-0. 2021.
3. Karaçam Z, Çelik D. The prevalence and risk factors of gestational diabetes mellitus in Turkey: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2019;2:1-11.
4. Johns EC, Denison FC, Norman JE, Reynolds RM. Gestational Diabetes Mellitus: Mechanisms, Treatment, and Complications. Trends in Endocrinology & Metabolism 2018;29(11):743-754.
5. Hoseini S, Hantoushzadeh S, Shoar S. Evaluating the extent of pregravid risk factors of gestational diabetes mellitus in women in Tehran. Iran Red Crescent Med J 2011;13:407–14.
6. American Diabetes Association (ADA). Gestational diabetes mellitus. Diabetes Care 2004;27(1):88–90. Allen C, Bowdin S, Harrison RF, et al. Pregnancy and perinatal outcomes after assisted reproduction: a comparative study. Ir J Med Sci 2008;177:233–241.
7. Palomba S, Homburg R, Santagni S, La Sala GB, Orvieto R. Risk of adverse pregnancy and perinatal outcomes after high technology infertility treatment: a comprehensive systematic review. Reprod Biol Endocrinol 2016;14(1):76.
8. Sabban H, Zakhari A, Patenaude V, Tulandi T, Abenhaim HA. Obstetrical and perinatal morbidity and mortality among in-vitro fertilization pregnancies: a population-based study. Arch Gynecol Obstet 2017;296:107–113.

9. Storgaard M, Loft A, Bergh C, et al. Obstetric and neonatal complications in pregnancies conceived after oocyte donation: a systematic review and meta-analysis. BJOG 2017;124:561–572.
10. Jones BJ, Zollner J, Haynes S, Cheng F, Dornhorst A. In vitro fertilization treatment influences glucose tolerance in multiple pregnancy. Diabetic Medicine 2013;30(2):252–254.
11. Ashrafi M, Gosili R, Hosseini R, Arabipoor A, Ahmadi J, Chehrazi M. Risk of gestational diabetes mellitus in patients undergoing assisted reproductive techniques. Eur J Obstet Gynecol Reprod Biol 2014;176:149–152.
12. Zhu L, Zhang Y, Liu Y, et al. Maternal and live-birth outcomes of pregnancies following assisted reproductive technology: a retrospective cohort study. Sci Rep 2016;6:35141.
13. Qin J, Liu X, Sheng X, Wang H, Gao S. Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a metaanalysis of cohort studies. Fertil Steril 2016;105(1):73–85.
14. Cai S, Natarajan P, Chan JKY, et al. Maternal hyperglycemia in singleton pregnancies conceived by IVF may be modified by first-trimester Hum Reprod 2017;32(9);1941–1947.
15. Mohammadi M, Morasae E K, Maroufizadeh S, Almasi-Hashiani A, Navid B, Amini P, et al. Assisted reproductive technology and the risk of gestational diabetes mellitus: a systematic review and meta-analysis. Middle East Fertility Society Journal 2020;25(1):6.
16. Saraç M, Koç I. Prevalence and risk factors of infertility in Turkey: evıdence from demographic and health surveys, 1993-2013. Journal of Biosocial Sciences 2018;50(4):472-490.
17. Lucovnik M, Blickstein I, Mirkovic T, et al. Effect of pre-gravid body mass index on outcomes of pregnancies following in vitro fertilization. J Assist Reprod Genet 2018;35:1309–1315.
18. Türkiye Endokrinoloji ve Metabolizma Derneği (Endocrinology and Metabolism Association of Turkey (TEMD)). Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu (Diagnosis and treatment of temd diabetes mellitus and complications) (14th ed.). Ankara: Bayt Printing Press. 2020. ISBN:978-605-4011-40-7. (Original work published in Turkish.)
19. American Society for Reproductive Medicine (ASRM). Age and Fertility, A Guide for Patients Revised. Birmingham, Alabama, 2012;1-16.
20. Woo I, Hindoyan R, Landay M, et al. Perinatal outcomes after natural conception versus in vitro fertilization (IVF) in gestational surrogates: a model to evaluate IVF treatment versus maternal effects. Fertil Steril 2017;18(6):993-998.
21. Bosdou JK, Anagnostis P, Goulis DG, et al. Risk of gestational diabetes mellitus in women achieving singleton pregnancy spontaneously or after ART: a systematic review and meta-analysis. Hum Reprod Update 2020;26(4),514-544.
22. Kouhkan A, Khamseh ME, Moini A, et al. Predictive factors of gestational diabetes in pregnancies following assisted reproductive technology: a nested case–control study. Arch Gynecol Obstet 2018;298:199–206.
23. Kouhkan A, Khamseh ME, Moini A, et al. Predictive factors of gestational diabetes in pregnancies following assisted reproductive technology: a nested case–control study. Arch Gynecol Obstet 2018;298:199–206.
24. Moaddab A, Chervenak FA, Mccullough LB, et al. Effect of advanced maternal age on maternal and neonatal outcomes in assisted reproductive technology pregnancies. Eur J Obstet Gynecol Reprod Biol 2017;216,178–183.
25. Wang YA, Nikravan R, Smith HC, Sullivan EA. Higher prevalence of gestational diabetes mellitus following assisted reproduction technology treatment. Hum Reprod 2013;28 (9): 2554–2561.
26. Budinetz TH, Mann JS, Griffin DW, Benadiva CA, Nulsen JC, Engmann LL. Maternal and neonatal outcomes after gonadotropin-releasing hormone agonist trigger for final oocyte maturation in patients undergoing in vitro fertilization. Fertil Steril 2014;102,753-8.
27. Jie Z, Yiling D, Ling Y. Association of assisted reproductive technology with adverse pregnancy outcomes. Iran J Reprod Med 2015;13,(3):169-180.
28. Joseph DN, Whirledge S. Stress and the HPA Axis: Balancing Homeostasis and Fertility. Int J Mol Sci 2017;18:2224.
29. Gordon JD, Speroff L, editors. Clinical Gynecologic Endocrinology and Infertility. (Translation: Işık AZ, Vicdan K.) Istanbul, Nobel Press. 2003. (Original work published in Turkish.)
30. Arcari AJ, Freire AV, Escobar ME, et al. One-year treatment with gonadotropin-releasing hormone analogues does not affect body mass index, insulin sensitivity or lipid profile in girls with central precocious puberty. Ann Pediatr Endocrinol Metab 2019;32(2).
31. Zipori Y, Lauterbach R, Matanes E, Beloosesky R, Weiner Z, Weissman A. Vaginal progesterone for the prevention of preterm birth and the risk of gestational diabetes. Eur J Obstet Gynecol Reprod Biol 2018;230, 6-9.