Evaluation of Maternal and Neonatal Outcomes in Women Are Conceived Through Assisted Reproductive Technology Compared to Other Fertility Treatments and Naturally Conceived Women: It is a Retrospective Cohort Study Conducted Over a 5-year Period At a Fertility Center in a Lebanese Hospital

Active, not recruiting

• Conditions: Preterm Birth; Gestational Diabetes Mellitus (GDM); Gestational Hypertension

• Registration Number: NCT06836843
• Lead Sponsor: Lebanese University

Brief Summary

Background: The number of couples experiencing difficulties conceiving and seeking treatment for infertility has increased dramatically over time. Treatment options for infertility have evolved significantly over the past four decades, expanding to include assisted reproductive technologies (ART). However, the impact of ART on pregnancy outcomes remains unclear. Studies have shown that ART pregnancies are associated with a higher risk of maternal and neonatal adverse outcomes compared to those resulting from spontaneous conception. To this date, no comprehensive studies have been conducted in Lebanon to assess this association. Therefore, it is crucial to evaluate whether Lebanese women who conceive via ART are at higher risk for maternal and birth-related complications.

Objective: The aim of this study is to evaluate maternal and neonatal outcomes among women who conceived through assisted reproductive technology (ART), compared to those who conceived via other fertility treatments or naturally, at Dr. Ghazeeri's clinic at the American University of Beirut Medical Center.

Methods: Investigators propose to conduct an observational retrospective cohort study involving all pregnant women treated by Dr. Ghazeeri who delivered at the American University of Beirut Medical Center between 2018 and 2023. Pregnancies exposed to assisted reproductive technology (ART) or other fertility treatments will be matched to a group of spontaneous pregnancies based on propensity scores. The study has been initiated following approval from the Institutional Review Board (IRB) at the American University of Beirut Medical Center. Data analysis will be performed using SPSS version 26.

Expected Results: If no associations are found between ART or other fertility treatments and an increased risk of maternal and neonatal outcomes, the results will provide reassurance for mothers seeking these treatments. However, if associations are identified, policymakers will need to establish comprehensive regulations outlining the appropriate use of these technologies. Additionally, these findings would lay the groundwork for obstetricians to implement closer monitoring and more careful management during pregnancy.

Detailed Description

i. Study Design Investigators propose to conduct an observational retrospective cohort study on all pregnant women who delivered at Dr. Gahzeeri's clinic at the American University of Beirut Medical Center between 2018 and 2023. Investigators have obtained approval from the Institutional Review Board (IRB) at AUB, which is valid until August 2025.

ii. Sample Size: As this is a retrospective cohort study, the sample size will be determined by the number of participants who meet the inclusion criteria.

iii. Population The patient characteristics will be extracted from the Epic electronic health record system at the hospital. Pregnancies exposed to ART or other fertility treatments will be matched to spontaneous pregnancies based on propensity scores

In this study, the subjects will be divided into two groups:

1. Exposed group:

* Group One (ART group): pregnancies conceived via either IVF/ICSI and/or Assisted hatching (AH) and/or Pre-implantation genetic testing (PGT).

* Group one will also be subdivided into fresh embryo transfer (ET) and frozen embryo transfer (FET) subgroups based on the type of embryo transfer method used.

* Group Two (Non-ART group): pregnancies conceived through ovulation induction (OI) and/or intrauterine insemination (IUI) and/or corrective gynecological surgery.

2. Non-exposed group: spontaneous pregnancies, defined as pregnancies resulting from natural conception.

Study Timeline

• Study Start: 2023-09-01
• Primary Completion: 2024-09-30
• Study First Submitted: 2024-12-10
• Status Verified: 2025-02
• Study First Submitted QC: 2025-02-14
• Last Update Submitted: 2025-02-14
• Study First Posted: 2025-02-20
• Last Update Posted: 2025-02-20
• Study Completion: 2025-08

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: Female
• Target Recruitment: 1000

Inclusion Criteria

• All pregnant ladies of Lebanese Nationality only who delivered at the American University of Beirut Medical Center (AUB-MC) between Nov 2018- Nov 2023
• Pregnancies that were delivered at least 20 weeks of gestation (≥ 20 weeks)
• All pregnant women who are in procreation age (20-50 years old)
• For pregnant women by ART: only if ART is done at the AUB-MC
• Subject's file being accessible for all the three trimesters
• Subjects being followed up until delivery only at the AUB-MC
• Subjects whom their baby or babies' records are available (it could be multiples)

Exclusion Criteria

• Subjects who started their follow-up after the 1st trimester (missing data before 12 weeks).
• All subjects with history of severe chronic conditions before gestation such as, pre-existing cancer, heart diseases (coronary artery disease, arrhythmia, cardiac defects, ischemic stroke, venous thromboembolism, liver disease and/or kidney disease, history of nervous system disorders (seizures, depression).
• Subjects who undergone ART elsewhere
• Subjects who lost to follow up during their pregnancies (missing data)
• Moms who delivered outside the AUBMC hospital

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Percentage of Pregnant Women with Gestational Diabetes Mellitus (GDM) in the Exposed Group versus Non-Exposed Group	24-28 weeks of gestation	GDM will be diagnosed using standardized glucose screening tests; Oral Glucose Tolerance Test (OGTT) between 24 and 28 weeks of gestation.; One-hour OGTT (after drinking a 50g glucose solution): Different cut-off thresholds are used for the 50-g glucose tolerance screening to be considered an abnormal result, including ≥130 mg/dL , ≥135 mg/dL, and ≥140 mg/dL.; * Possible Gestational Diabetes (possible diagnosis if ≥140 mg/dL); and here the patient requires a confirmatory diagnosis which is the three-hours OGTT (after drinking 100g glucose solution): * Normal \<140 mg/dL; * Gestational Diabetes ≥140 mg/dL
Percentage of Pregnant Women with Gestational Hypertension in the Exposed Group versus the Non-Exposed Group	from 20 weeks + 1 day to 40 weeks of gestation	Gestational hypertension is confirmed when blood pressure greater than or equal to 140mmHg systolic or 90mmHg diastolic on 2 separate occasions at least 4 hours apart after 20 weeks of pregnancy when previous blood pressure was normal
Percentage of Babies Born Preterm to Women in the Exposed Group versus Non-Exposed Group	Before 37 weeks of gestation	Preterm is defined as babies born alive before 37 weeks of pregnancy are completed.
Percentage of Babies Born Small for Gestational Age to Women in the Exposed Group versus Non-Exposed Group	day one of birth	Infants with a birth weight below the 10th percentile for their gestational age.
Percentage of Babies Born Large for Gestational Age to Women in the Exposed Group versus Non-Exposed Group	day one of birth	Infants with a birth weight above the 90th percentile for their gestational age

Secondary Outcome Measures

Name	Time	Method
Percentage of Pregnant Women with Polyhydramnios in the Exposed Group versus Non-Exposed Group	During 40 weeks of gestation	Polyhydramnios is usually defined as an amniotic fluid index (AFI) of more than 24 cm or a single pocket of fluid at least 8 cm in depth that results in an amniotic fluid volume of more than 2000 ml.
Percentage of Pregnant Women with Oligohydramnios in the Exposed Group versus Non-Exposed Group	During 40 weeks of gestation	It is defined as an amniotic fluid index (AFI) less than 7 cm or the absence of a fluid pocket 2-3 cm in depth

Trial Locations

Locations (1)

Lebanese University; 🇱🇧 Beirut, Hadath, Lebanon