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Minerva Obstetrics and Gynecology 2021 May 05

DOI: 10.23736/S2724-606X.21.04806-5

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Ovarian hyperstimulation syndrome and adverse pregnancy outcome: a systematic review and meta-analysis

Danilo BUCA 1, Francesco D’ANTONIO 1, Marco LIBERATI 1, Sara TINARI 1, Giorgio PAGANI 2, Pantaleo GRECO 3, Luigi NAPPI 4

1 Center for Fetal Care and High Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy; 2 Department of Obstetrics and Gynecology, Fondazione Poliambulanza, Brescia, Italy; 3 Department of Morphology, Surgery, and Experimental Medicine, Section of Obstetrics and Gynecology, University of Ferrara, Sant'Anna University Hospital, Ferrara, Italy; 4 Fetal Medicine Unit, Department of Medical and Surgical Sciences, Department of Obstetrics and Gynecology, University of Foggia, Foggia, Italy


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PURPOSE OF THE ARTICLE: To investigate the association between ovarian hyperstimulation syndrome (OHSS) and adverse pregnancy outcome.
MATERIAL AND METHODS: Medline, Embase and Cochrane databases were searched. The primary outcome was a composite score of adverse maternal outcome including either preterm birth (PTB), gestational diabetes mellitus (GDM), pre-eclampsia (PE) or pregnancy induced hypertension, intra-hepatic cholestasis of pregnancy, thromboembolic events or need for caesarean section (CS). Secondary outcomes were a composite score of adverse fetal outcome including either miscarriage, low birthweight, fetal anomalies or intra-uterine fetal death (IUD) and the individual components of both primary and secondary outcomes.
RESULTS: 13 studies (3303 ART pregnancies with and 89720 without OHSS) were included. The risk of composite adverse maternal outcome (RR: 8.8, 95% CI 8.1-9.5) was higher in women with compared to those without OHSS. The association between OHSS and adverse pregnancy outcome was mainly due to the higher risk of PTB (RR: 11.4, 95% CI 10.5-12.4), while there was no difference in the risk of others primary outcome. Likewise, the risk of composite fetal outcome was higher in pregnancies with a prior OHSS (RR: 1.5, 95% CI 1.1-2.0). The strength of association between OHSS and composite adverse maternal outcome persisted when considering singleton pregnancies or those with severe disease.
CONCLUSIONS: Pregnancies complicated by OHSS are at high risk of adverse pregnancy outcome, especially PTB.


KEY WORDS: Ovarian hyperstimulation syndrome; Pregnancy; Outcome

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