Preventing Preeclampsia in IVF pregnancies
Ideal Fertility IVF and Genetic Center private Limited, Jabalpur,India12 May 2023
Can We prevent Preeclampsia
What are the novel findings of this work
Preeclampsia and pregnancy induced hypertension is one the major cause of maternal mortality and morbidity. There is continuous effort to identify the cases in early pregnancy or even identifying risk factor in early pregnancy to start anti inflammatory drug esp.Low dose aspirin. Even after this there are major chunk of pregnant patient who suffer from moderate to severe hypertension and HELLP syndrome and even eclampsia. Intra uterine growth retardation is one of major problem for fetal mortality and morbidity along with complications of prematurity.
What are the clinical implication of this work
This work is with large data with an intervention prior to pregnancy contemplation. All the pregnancies are followed till delivery. Large number are with high risk factor for development of preeclampsia. There were no pregnancy induced hypertension or preeclampsia in this large group. So intervention in early or before pregnancy may eliminate this menace and help to reduce this major problem in society and improve maternal and fetal survival to a great extent
Objective : To reduce the stress on cellular hyperplasia happening at the time of implantation and early part of pregnancy with spiral artery remodeling , so that there is minimal release of inflammatory factors in maternal circulation. This reduction of cellular stress is postulated by providing adequate supply of energy by way of maintaining the stored form of iron, that is serum Ferritin. This way serum iron can be maintained and thus the level of hemoglobin.
Method : This was a retrospective cohort study. It started mainly to prevent early pregnancy anemia. This study conducted at Ideal Fertility IVF and Genetic Centre private limited Jabalpur India. Total 335 pregnant patients are followed ( IVF 304 and spontaneous 31) from January 2020 to December 2022. It was observed that when serum ferritin was below 41 ng/ml, injection Ferric Carboxymaltose 1000 mg was infused in 300 ml of normal saline in 20 minutes ( to improve stored form of iron). It was observed retrospectively that even though majority of pregnancies are IVF pregnancies ( which is high risk factor for pregnancy induced hypertension), not a single woman developed hypertension and its complication.
Results : In total, 335 patents are followed. Blood pressure was measured at each antenatal checkup and recorded. Upper limit for defining the hypertension was 140/90 mmhg. All the patients were below this limit and had healthy delivery
Conclusion: This study and observation demonstrate that, correcting serum ferritin level before or at the beginning of pregnancy not only reduced anemia but significantly reduces incidence of pregnancy induced hypertension and preeclampsia. It also reduced the incidence of Fetal Growth Retardation. This study can be corroborated by other methods of supplying iron before or early part of pregnancy. Correcting serum ferritin before pregnancy or early part of pregnancy at larger scale may reduce the burden of pregnancy induced hypertension and pre-eclampsia and eclampsia, which is major cause of maternal mortality in India and the whole world.
[Note: This study has not been peer reviewed by IVF.net]