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#Grand Rounds

Is IVF an Independent Risk Factor for Placenta Accreta Spectrum?

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BACKGROUND AND PURPOSE:

  • There is evidence that IVF may be associated with placenta accreta spectrum (PAS), particularly with cryopreserved embryo transfer
  • Salmanian et al. (AJOG, 2020) assessed whether IVF was an independent risk factor for PAS

METHODS:

  • Retrospective analysis of a prospective, population-based cohort (2012 to 2019)
  • Participants
    • All patients giving birth in a university hospital system
  • Study design
    • Models were designed to predict PAS and adjusted for important risk factors (e.g. placenta previa and previous cesarean delivery)
    • Adjusted odds ratios (OR) were calculated from multivariate regression analyses
  • Primary outcome
    • PAS disorder (confirmed by histopathology)

RESULTS:

  • 37,461 deliveries
    • History of cesarean: 15%
    • Placenta previa in their index pregnancy: 0.7%
    • IVF pregnancy: 1.5%
  • The following were identified as independent risk factors for PAS
    • IVF: aOR 8.7 (95% CI, 3.8 to 20.3)
    • History of prior cesarean: aOR 21.1 (95% CI, 11.4 to 39.2)
    • Presence of placenta previa: aOR 94.6 (95% CI, 29.3 to 305.1)
  • IVF risk was adjusted to consider the number of prior cesarean deliveries | Risk still remained taking in to account prior cesarean delivery vs no cesarean delivery
    • 1 prior cesarean deliveries: aOR 10.1 (95% CI, 5.1 to 20.2)
    • 2 prior cesarean deliveries: aOR 13.7 (95% CI, 6.3 to 29.9)
    • 3 prior caesarean deliveries: aOR 34.5 (95% CI, 14.1 to 84.6)
    • 4 prior cesarean deliveries: aOR 49.1 (95% CI, 17.0 to 141.7)

CONCLUSION:

  • IVF is an independent risk factor for PAS
  • However, the authors point out that compared to placenta previa and previous cesarean delivery, the clinical importance of IVF is considerably less

Learn More – Primary Sources:

In vitro fertilization as an independent risk factor for placenta accreta spectrum

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Related ObG Topics:

Placenta Accreta Spectrum Disorder: Definitions and Management
Does Prenatal Diagnosis of Placenta Accreta Help Reduce Adverse Perinatal Outcomes?
What is the Risk of Morbidity in Pregnancies Following Accreta?
Placenta Accreta Spectrum: What is the Effect of Placental Location?

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