Becky McCall

October 02, 2015

STOCKHOLM — Use of assisted-reproduction technology increases the risk of gestational diabetes by about 30%, although the prognosis for these women is similar to that of those who have normal pregnancies, new research from France indicates.

"In France, we have selective screening for gestational diabetes. But we see from these results that women who have no risk factors for gestational diabetes should be screened because they have received assisted reproduction," noted Emanuel Cosson, MD, PhD, of Jean Verdier Hospital, Paris, France, who presented the results at the recent European Association for the Study of Diabetes (EASD) 2015 Meeting.

Pregnancies after assisted reproduction are generally associated with poor prognosis, including more gestational diabetes, but it has not been clear whether this was due to confounding factors, including age or twin pregnancies, according to Dr Cosson.

He explained that this study aimed to determine whether the relationship between assisted reproduction and gestational diabetes was due to the hormonal environment of the pregnant mother or to assisted-reproduction procedures.

It also aimed to understand the prognosis for assisted-reproduction pregnancies with gestational diabetes. "We have few data relating to the prognosis of gestational diabetes [in assisted reproduction], so we wanted to determine whether assisted reproduction confers a worse prognosis for it."

Commenting on the results, session moderator Alexandra Kautzky-Willer, MD, from the University of Vienna, Austria, said women who have assisted reproduction before pregnancy have more risk factors for gestational diabetes, and as such, she pointed out, "I think women should be selectively screened."

And she asserted that screening for prediabetes should also be conducted before assisted reproduction is initiated.

"Often we see diabetic women at 20 weeks of gestation being treated, and this isn't good. We need to check the glucose-tolerance state before the assisted-reproduction procedure. If the patient is found to be prediabetic or diabetic, then treat before the assisted reproduction.

"However, women with gestational diabetes have the same prognosis as all pregnant women, and clinicians should treat them with routine clinical care," she told Medscape Medical News in an interview.

Of Total Study Cohort, 3% of Pregnancies Followed Assisted Reproduction

Dr Cosson and his colleagues analyzed the prevalence of gestational diabetes and of gestational-diabetes–related events such as preeclampsia, birth weight at least 4 kg, or shoulder dystocia in the 18,305 women without known diabetes who delivered in a hospital in Bondy, France.

Pregnancies occurred between 2002 and 2010 after either natural conception (n=17,697) or assisted reproduction (n=608); none of the women were affected by diabetes at baseline.

Multivariate analysis was carried out to adjust for factors associated with gestational diabetes, including age, body mass index (BMI), familial history of diabetes, history of gestational diabetes or macrosomic child, history of miscarriage, multiparity, smoking before pregnancy, hypertension, twin pregnancy, and origin/ethnicity.

The 453 women undergoing assisted reproduction represented 3.3% of the total assessed cohort, and procedures included in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and 77 transfers; 155 further women had ovulation-induction only.

Patients were universally screened for gestational diabetes. Mean BMI was 24 kg/m², mean age was 30 years, and 58.8% had at least one risk factor for gestational diabetes.

The Way Assisted Reproduction May Up Diabetes Risk Is Unknown

There was a greater rate of gestational diabetes after assisted reproduction than after the spontaneous pregnancies (17.6% vs 14.2%, P < .05).

The prevalence of gestational diabetes was 15.5% after ovulation induction only and 18.3% after ovulation induction followed by assisted-reproduction procedure.

Dr Cosson also reported that generally, women with gestational diabetes compared with those without were more likely to be overweight (36.9% vs 34.4%), to have had a prior miscarriage (19.6% vs 17.8%), a family history of diabetes (23.9% vs 20.1%), or a history of gestational diabetes (14.7% vs 2.6%).

Upon multivariate analysis, women who had assisted reproduction compared with those who had spontaneous pregnancies or pregnancies after ovulation induction only had a higher risk of gestational diabetes with an odds ratio of 1.32 (P < 0.05), independent of other risk factors.

However, "The way assisted reproduction procedures may lead to an increased rate of gestational diabetes remains unclear," Dr Cosson told Medscape Medical News.

Prognosis Similar for Assisted Reproduction and Pregnancy

But the prognosis of gestational diabetes — as assessed by birth weight of at least 4 kg, preeclampsia, and shoulder dystocia — according to the type of pregnancy, "appears to be similar or even better after ovulation induction and assisted reproduction than after natural pregnancies," Dr Cosson noted.

In conclusion, he said that if screening for gestational diabetes is selective, it should always be performed when pregnancy follows assisted reproduction.

Dr Cosson and Dr Kautzky-Willer have declared no relevant disclosures.

European Association for the Study of Diabetes (EASD) 2015 Meeting; Stockholm, Sweden. Abstract 146, presented September 17, 2015.


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