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Geburtshilfliche Risiken nach assistierter Reproduktion

Obstetric risks after assisted reproduction

  • Leitthema
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Der Gynäkologe Aims and scope

Zusammenfassung

Hintergrund

Der Anteil Neugeborener nach assistierter Reproduktion (ART) nimmt in den letzten Jahren stetig zu und beträgt aktuell in Deutschland ca. 3 %. Geburtshilfliche Risiken und neonatales Outcome nach ART stehen daher zunehmend im Fokus aktueller Studien.

Fragestellung

Besteht hinsichtlich Schwangerschaftskomplikationen und neonatalen Risiken eine erhöhte Inzidenz nach ART?

Material und Methoden

Der Artikel basiert auf einer ausführlichen Literaturrecherche unter Verwendung medizinischer Datenbanken (u. a. PubMed).

Ergebnisse

Nach ART besteht ein erhöhtes Risiko für u. a. Präeklampsie, Frühgeburtlichkeit, niedriges Geburtsgewicht und Fehlbildungen im Vergleich zu spontan konzipierten Graviditäten. Da insbesondere die erhöhte Rate an Mehrlingsschwangerschaften nach ART als wesentlicher Risikofaktor angesehen wird, sollte nach individueller Abwägung zunehmend ein Single-embryo-Transfer (SET) angestrebt werden. In aktuellen Studien tritt die Subfertilität per se als unabhängiger Risikofaktor in den Vordergrund, auch wenn ein Kausalzusammenhang zwischen extrakorporalen Techniken, Schwangerschaftskomplikationen und perinatalem Risiko nicht ausgeschlossen werden kann.

Schlussfolgerung

ART-induzierte Graviditäten sind generell als Risikoschwangerschaften einzustufen, die eine engmaschige Überwachung erfordern. Sub- bzw. infertile Paare müssen vor Beginn einer Kinderwunschbehandlung über die möglichen Risiken aufgeklärt werden. Sowohl das Verfahren der ART als auch die Subfertilität an sich haben, wenn auch in unterschiedlichem Ausmaß, einen synergistischen, additiven Effekt bezogen auf die Inzidenz geburtshilflicher Risiken.

Abstract

Background

The proportion of neonates born after assisted reproductive technology (ART) has been constantly rising in the last few years and nowadays represents 3% of births in Germany. Therefore, clinical trials are increasingly focusing on obstetric risks and neonatal outcome following ART.

Objective

Is there an increased incidence of complications during pregnancy and neonatal risks following ART?

Material and method

This article is based on an extensive literature search in medical databases including PubMed.

Results

Following ART there is an increased risk for e.g. pre-eclampsia, prematurity, low birth weight and malformations compared to naturally conceived pregnancies. As the increased rate of multiple pregnancies represents a substantial risk factor following ART, single embryo transfer should be strived for after consideration of the individual circumstances. Current clinical trials focus on subfertility per se as an independent risk factor, even though a causal relationship between extracorporeal techniques, pregnancy complications and perinatal risks cannot be excluded.

Conclusion

Pregnancies following ART are generally classified as high risk pregnancies and should be closely monitored. Couples suffering from subfertility or infertility should be informed about possible risks before starting fertility treatment. The procedure of ART as well as subfertility per se have a synergistic and additive effect in relation to the incidence of obstetric risks, albeit to varying degrees.

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Authors and Affiliations

  1. Facharzt-Zentrum für Kinderwunsch, Pränatale Medizin, Endokrinologie und Osteologie, Amedes, Mönckebergstr. 10, 20095, Hamburg, Deutschland

    Sebastian Grewe & Klaus Diedrich

  2. Kinderwunsch Bremen, Bremen, Deutschland

    Christoph Grewe

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  1. Sebastian Grewe
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  2. Christoph Grewe
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  3. Klaus Diedrich
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Correspondence to Sebastian Grewe.

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Interessenkonflikt

S. Grewe, C. Grewe und K. Diedrich geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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K. Diedrich, Groß Sarau

B. Sonntag, Hamburg

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Grewe, S., Grewe, C. & Diedrich, K. Geburtshilfliche Risiken nach assistierter Reproduktion. Gynäkologe 52, 659–666 (2019). https://doi.org/10.1007/s00129-019-4486-7

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  • DOI: https://doi.org/10.1007/s00129-019-4486-7

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