Hypertensive disorders of pregnancy and gestational diabetes mellitus affect fetal growth and perinatal outcomes in women undergoing in vitro fertilization.

Background: Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are common complications that adversely affect pregnancy outcomes. However, data on their independent and combined impacts on fetal growth and perinatal outcomes in in vitro fertilization (IVF) pregnancies are limited. Objectives: To investigate risks of abnormal fetal growth and perinatal outcomes following conventional IVF treatment across distinct groups categorized by GDM-affected, HDP-affected, HDP/GDM comorbidity (HDP/GDM), and those unaffected by neither disorder (unaffected). Study design: In this retrospective cohort study, we analyzed data from 20,907 women who achieved singleton deliveries during their first IVF cycles. Multivariate logistic regression analysis was performed to evaluate the effects of HDP and GDM on fetal and perinatal outcomes, adjusting for confounding factors. Results: Compared to unaffected IVF pregnancies, those complicated by HDP alone showed significantly increased risks of small for gestational age (SGA) infants (aOR 5.67, 95% CI 4.56-7.04, P<.001), low birthweight (aOR 7.37, 95% CI 6.00-9.06, P<.001), preterm delivery, and cesarean section. Pregnancies affected by GDM alone were associated with increased risks of SGA (aOR 1.34, 95% CI 1.04-1.72, P=.023), low birthweight (aOR 1.55, 95% CI 1.20-1.99, P<.001), large for gestational age (LGA) infants (aOR 1.24, 95% CI 1.11-1.39, P<.001), macrosomia (aOR 1.24, 95% CI 1.06-1.45, P=.005), preterm delivery, and cesarean section. The co-occurrence of HDP and GDM further elevated the risk of SGA (aOR 6.37, 95% CI 3.63-11.18, P<.001), low birthweight (aOR 7.77, 95%CI 4.70-12.84, P<.001), preterm delivery, and cesarean section. Conclusions: IVF pregnancies affected by HDP or GDM exhibit risk profiles for abnormal fetal growth and adverse perinatal outcomes similar to those observed in naturally conceived pregnancies. The combined impact of HDP and GDM significantly exacerbates these risks. Importantly, these adverse outcomes are consistent regardless of whether the embryos transferred were fresh or frozen.