The impact of ovulation induction and ovarian stimulation on the risk of pregnancy-induced hypertension and on neonatal outcomes: A case/ control study

Objectives: To study the role of ovarian stimulation procedures on the risk of pregnancy-induced hypertension, gestational diabetes mellitus and neonatal outcomes according to women's characteristics and the causes of infertility. Design: Retrospective, observational, case/control study. Patients: Spontaneous pregnancies (group A, n = 8107), pregnancies achieved after mild ovarian ovulation induction without other Assisted Reproductive Technology (ART) procedures (group B, n =44), pregnancies after mild ovarian stimulation and ART procedures (group C, n=53) or pregnancies after multi (>2) follicular stimulation with gonadotrophin therapy and ART procedures (group D, n = 133); all of the groups had identical protocols for prenatal care. Main outcome measurements: Pregnancy-induced hypertension (PIH), fetal macrosomia (estimated fetal weight >90th percentile), gestational diabetes mellitus, caesarean section, and neonatal outcomes. Results: The incidence rates of PIH (2.7,11.6,4.2, and 2.5%) in groups A, B, C and D, respectively, (p = 0.004), fetal macrosomia (4.7, 7.0, 20.8, and 7.6%, respectively, p <0.001), caesarean section (21.8,37.2, 21.7, and 17.6%, respectively, p = 0.048), differed among the groups. The high incidence of PIH in pregnancies following ovulation induction was driven by polycystic ovarian syndrome (PCOS) per se. Conclusion: PCOS per se was associated with more PIH, and ART procedures after mild mono/bi follicular ovarian stimulation were associated with more fetal macrosomia. (C) 2017 Published by Elsevier Ireland Ltd.