The Association of Assisted Reproductive Technology with Placental and Umbilical Abnormalities

Abstract

Objective: Global utilization of assisted reproductive technology (ART) is increasing; however, it is associated with adverse perinatal outcomes. Placental and umbilical cord abnormalities contribute significantly to these negative outcomes. However, it remains unclear whether ART independently increases the risk of such abnormalities. This study aimed to investigate the association between ART and key umbilico-placental abnormalities, after adjustment for confounders. Methods: In this retrospective cohort study, singleton pregnancies receiving routine antenatal care (January 2015 to June 2024) at the 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece, were analyzed. Pregnancies conceived via ART were compared to those conceived spontaneously. To investigate placental and cord anomalies, this study employed multiple logistic regression. This approach adjusted for various confounders, including maternal age, BMI, parity, smoking status, history of previous cesarean section, diabetes mellitus, and thyroid disease. Results: This study included a total of 13,854 singleton pregnancies, of which 647 were conceived via ART. ART was significantly associated with an increased risk of placenta previa (aOR 1.99, 95% CI 1.10-3.61), low-lying placenta (aOR 1.71, 95% CI 1.38-2.11), bilobate placenta (aOR 2.81, 95% CI 1.92-4.11), single umbilical artery (aOR 2.62, 95% CI 1.022-6.715), marginal (aOR 1.63, 95% CI 1.32-2.01) and velamentous cord insertion (aOR 3.13, 95% CI 1.98-4.95), and vasa previa (aOR 5.51, 95% CI 1.28-23.76). Conclusions: ART-conceived pregnancies appear to carry a higher risk for certain placental and umbilical cord abnormalities, potentially contributing to adverse perinatal outcomes. Further studies are required to investigate the pathophysiology underlying these associations.

Keywords: assisted reproductive technology; bilobate placenta; in vitro fertilization; low-lying placenta; placenta previa; single umbilical artery; vasa previa; velamentous cord insertion.

Figure 1

Flowchart of patient inclusion in this study.

Figure 2

Covariate balance of the investigated populations before and after propensity score matching. Legend: The vertical dashed lines at ±0.1 standardized mean difference represent the conventional threshold for acceptable balance; * denotes the categorical variables.