Placenta. 2025 Apr 25;167:55-62. doi: 10.1016/j.placenta.2025.04.022. Online ahead of print.
ABSTRACT
OBJECTIVE: To evaluate the impact of in vitro fertilization and embryo transfer (IVF-ET) on pregnancy outcomes among women of advanced maternal age (AMA, ≥35 years), compared with spontaneous conceptions.
METHODS: This retrospective cohort study analyzed 20,882 AMA singleton pregnancies (≥24 weeks) at a large tertiary maternity hospital in Shanghai, China. Outcomes were evaluated using stabilized IPTW-adjusted log-binomial regression and mediation analysis.
RESULTS: IVF-ET was associated with increased risks of placental abnormalities (adjusted risk ratio (aRR) = 1.87, 95 % confidence interval (CI): 1.32-2.65), placental abruption (aRR = 1.68, 95 % CI: 1.33-2.13), placenta accreta (aRR = 2.52, 95 % CI: 1.34-4.72), placenta previa (aRR = 1.68, 95 % CI: 1.33-2.13), gestational diabetes mellitus (GDM, aRR = 1.30, 95 % CI: 1.16-1.45), preeclampsia (PE, aRR = 1.52, 95 % CI: 1.14-2.02), postpartum hemorrhage (aRR = 2.03, 95 % CI: 1.28-3.21), preterm birth (aRR = 1.31, 95 % CI: 1.04-1.64), cesarean section (CS, aRR = 1.19, 95 % CI: 1.13-1.24), neonatal asphyxia (aRR = 2.45, 95 % CI: 1.30-4.62), neonatal respiratory distress (aRR = 1.61, 95 % CI: 1.14-2.27), and neonatal jaundice (aRR = 1.36, 95 % CI: 1.09-1.70). Mediation analysis indicated that CS could explain 21.47 % and 26.15 % of IVF-ET’s effect on postpartum hemorrhage and neonatal jaundice, respectively.
CONCLUSION: AMA women undergoing IVF-ET are associated with an elevated risk of abnormal placentation, PE, GDM and preterm birth. Higher CS rates mediate adverse neonatal outcomes and an increased risk of postpartum hemorrhage.
PMID:40328094 | DOI:10.1016/j.placenta.2025.04.022
