OBJECTIVE
To determine the features of the course of pregnancy, the influence of the infertility factor and the cycle of stimulation of superovulation on obstetric and perinatal outcomes in patients with pregnancy after in vitro fertilization (IVF) complicated by gestational diabetes mellitus (GDM).
MATERIAL AND METHODS
The outpatient and inpatient records of 116 patients with singleton pregnancies that occurred after IVF in the period from 2018 to 2022 were retrospectively studied at V.I. Krasnopolsky Moscow Regional Scientific Research Institute of Obstetrics and Gynecology. The main group consisted of 77 (66%) patients after IVF with GDM, the comparison group consisted of 39 (34%) patients after IVF who did not develop GDM. The infertility factor, IVF protocol, GSM detection period, method and duration of delivery, and the presence of obstetric and perinatal complications were analyzed in the examined patients. All pregnant women in the studied groups were closely monitored by obstetricians, gynecologists and endocrinologists in order to timely diagnose and treat possible pregnancy complications. Statistical processing of the obtained data was performed using the Statistica v application software package. 13.3 (TIBCO, USA).
RESULTS
As a result of the study, there were no statistically significant differences between the groups in terms of short and long IVF protocols that could affect obstetric and perinatal outcomes. The groups were comparable in terms of infertility. There were no statistically significant differences in the incidence of obstetric complications in the examined groups. Diet therapy prevailed as a treatment method in the group with GDM (n=56 out of 77; 72.7%). In the early GDM group, 11 patients were on diet therapy, 7 on insulin therapy, and the onset was noted from 8 weeks of gestation. Delivery in the GDM group was more often performed by planned cesarean section (49.4%), in the comparison group — more often through natural birth routes (41.0%), however, there were no statistically significant differences between the groups in the frequency of delivery methods. The assessment of the condition of newborns on the Apgar scale of 8 and 9 points was statistically significantly more common in the group of patients with GDM than in the comparison group — in 94.8 and 79.5%, respectively.
CONCLUSION
Assessment of the possibility of developing early GDM in patients after the use of IVF is extremely important, as it contributes to adequate pre-pregnancy preparation. The division of risk factors for developing GDM after IVF into modifiable and non-modifiable factors contributes to improving the management strategy for patients in order to achieve optimal obstetric and perinatal outcomes. In the study, it was shown that the presence of an infertility factor, the use of a superovulation stimulation cycle in an IVF program, and the development of GDM in the examined patients did not significantly affect the timing of delivery, as well as the occurrence of obstetric and perinatal complications. Despite these findings, patients with a history of infertility who developed GDM after undergoing IVF are considered complicated patients who are at a high risk of developing complications during pregnancy and type 2 diabetes in the future. A personalized multidisciplinary approach is needed for each patient with infertility, both during preconception period, as well as when entering the IVF protocol, during pregnancy, when it is complicated by GDM.
