Antenatal diagnosis of placenta accreta spectrum after in vitro fertilization-embryo transfer: a systematic review and meta-analysis

Shinya Matsuzaki, Yoshikazu Nagase, Tsuyoshi Takiuchi, Aiko Kakigano, Kazuya Mimura, Misooja Lee, Satoko Matsuzaki, Yutaka Ueda, Takuji Tomimatsu, Masayuki Endo, Tadashi Kimura, Shinya Matsuzaki, Yoshikazu Nagase, Tsuyoshi Takiuchi, Aiko Kakigano, Kazuya Mimura, Misooja Lee, Satoko Matsuzaki, Yutaka Ueda, Takuji Tomimatsu, Masayuki Endo, Tadashi Kimura

Abstract

Increasing evidence suggests a relationship between in vitro fertilization-embryo transfer (IVF-ET) and placenta accreta spectrum (PAS). Some studies have reported a lower rate of antenatal diagnosis of PAS after IVF-ET compared to PAS with spontaneous conception. This study aimed to review the diagnostic accuracy of PAS after IVF-ET and to explore the relationship between IVF-ET pregnancy and PAS. According to the PRISMA guidelines, a comprehensive systematic review of the literature was conducted through August 31, 2020 to determine the effects of IVF-ET on PAS. In addition, a meta-analysis was conducted to explore the relationship between IVF-ET pregnancy and PAS. Twelve original studies (2011-2020) met the inclusion criteria. Among these, 190,139 IVF-ET pregnancies and 248,534 spontaneous conceptions met the inclusion criteria. In the comparator analysis between PAS after IVF-ET and PAS with spontaneous conception (n = 2), the antenatal diagnosis of PAS after IVF-ET was significantly lower than that of PAS with spontaneous conception (22.2% versus 94.7%, P < 0.01; < 12.9% versus 46.9%, P < 0.01). The risk of PAS was significantly higher in women who conceived with IVF-ET than in those with spontaneous conception (odds ratio [OR]: 5.03, 95% confidence interval [CI]: 3.34-7.56, P < 0.01). In the sensitivity analysis accounting for the type of IVF-ET, frozen ET was associated with an increased risk of PAS (OR: 4.60, 95%CI: 3.42-6.18, P < 0.01) compared to fresh ET. Notably, frozen ET with hormone replacement cycle was significantly associated with the prevalence of PAS compared to frozen ET with normal ovulatory cycle (OR: 5.76, 95%CI 3.12-10.64, P < 0.01). IVF-ET is associated with PAS, and PAS after IVF-ET was associated with a lower rate of antenatal diagnosis. Therefore, clinicians can pay more attention to the presence of PAS during antenatal evaluation in women with IVF-ET, especially in frozen ET with hormone replacement cycle.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Study selection schema for the systematic review of the literature.
Figure 2
Figure 2
Results of the meta-analysis for the effect of IVF-ET on PAS. The pooled odds ratio for (A) PAS, (B) placenta previa, and (C) PAS (patient background matched) between IVF-ET patients versus spontaneous conception patients are shown. Since the numbers after the third decimal places for the lower or upper confidence interval were omitted in most studies, some calculated values of OR using Revman ver. 5.4.1™ may be different from the original values. Abbreviations: PAS, placenta accreta spectrum; OR, odds ratio; CI, confidence interval; and IVF-ET, in vitro fertilization-embryo transfer.
Figure 3
Figure 3
The effect of fresh ET, frozen ET, FET with normal ovulatory cycle, and FET with hormone replacement cycle on PAS. The pooled odds ratio for PAS (A) fresh ET versus spontaneous conception, (B) frozen ET versus spontaneous conception, (C) fresh ET versus frozen ET, and (D) frozen ET with hormone replacement cycle versus frozen ET with normal ovulatory cycle are shown. Since the numbers after the third decimal places for the lower or upper confidence interval are omitted in most studies, some calculated values of OR using Revman ver. 5.4.1™ may be different from the original values. PAS placenta accreta spectrum, OR odds ratio, CI confidence interval, ET embryo transfer, FET frozen embryo transfer.

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