Obstetric outcomes in 102 pregnancies after preimplantation genetic diagnosis

OBJECTIVE: We sought to determine whether preimplantation genetic diagnosis is associated with particular pregnancy or delivery complications. STUDY DESIGN: A total of 102 consecutive pregnancies after preimplantation genetic diagnosis by polar body removal performed at Illinois Masonic Medic al Center resulting in 114 live births were analyzed. All patients were giv en a delivery and newborn questionnaire, and attempts were made to contact and question them regarding any pregnancy complications and type of deliver y. Permission was obtained to examine medical records and discuss the patie nt's pregnancy with her obstetrician when questions existed with respect to complications or indication for cesarean delivery. RESULTS: Delivery and newborn questionnaires were completed or telephone co ntact was achieved for 100 of the 102 pregnancies. There were 85 singleton, 9 twin, and 7 triplet pregnancies. Of the 7 triplet gestations, 3 couples elected multifetal pregnancy reduction to twins and healthy triplets were b orn to 4 couples between 32 and 36 weeks by cesarean delivery. Of the 80 si ngleton deliveries, 60 (75%) progressed to term. Of these 60 term singleton deliveries, 34 were vaginal, 23 were cesarean (40%), and 3 delivery types were unknown. The incidence of small-for-gestational-age infants was 3% for neonates in the 60 term singleton deliveries and 7% in the entire cohort o f 80 singleton deliveries. Only 3 pregnancy complications (other than prema ture delivery) were reported more than once. There were 3 instances each of gestational diabetes, intrauterine growth restriction, and pregnancy-induc ed hypertension. There was 1 case each of HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, congestive heart failure, mild oligoh ydramnios, and abruptio placentae, The indications for cesarean delivery we re (in descending order) failure of labor to progress (n = 7), fetal distre ss (n = 4), placenta previa (n = 4), elective repeat cesarean delivery (n = 4), triplets (n = 3), uterine scarring (n = 3), 1 twin in the breech posit ion (n = 3), failed forceps delivery (n = 2), and a variety of other indica tions that occurred in only 1 patient each. All preimplantation genetic dia gnoses were confirmed by prenatal or postnatal testing. No diagnostic error s were made in this cohort of patients or in any patients undergoing preimp lantation genetic diagnosis having polar body removal in our center. CONCLUSIONS: Preimplantation genetic diagnosis is associated with a risk of multiple gestations, cesarean delivery, and placenta previa. Cesarean deli very rates and multiple gestation rates are comparable to those of patients undergoing in vitro fertilization in general. The preimplantation genetic diagnosis itself does not seem to cause an increased risk for any particula r pregnancy complication, with the possible exception of placenta previa, w hich was seen in 4% of patients.