Retrospective analysis of pregnancies resulted from assisted reproductive technology in women with type 2 diabetes mellitus
Hypothesis/aims of study. Type 2 diabetes mellitus (T2D) is one of the most widespread diseases in the world. The etiology of this disease is associated with genetic, age and ethnic factors. It is generally accepted that a sedentary lifestyle and obesity can cause T2D. This illness has serious complications that affect the women's health and quality of life. It is well known that obesity and T2D are a common cause of anovulatory infertility in women of reproductive age. The number of T2D patients who are planning pregnancy by assisted reproductive technology (ART) has increased over the past 10 years. This study was aimed at investigating the effect of carbohydrate metabolism compensation in the preconception period on the outcomes of pregnancies resulted from in vitro fertilization (IVF) in T2DM women. Study design, materials, and methods. 51 T2D pregnancies after ART and their outcomes were analyzed retrospectively. Results. The age of the patients who applied to ART departments ranged from 27 to 46 years. The mean body mass index was 33.9 ± 6.5 kg/m2. The duration of infertility varied from 3 to 18 years. Infertility was caused by tubal occlusion in 17 cases, by anovulation in 16 cases, by male factor in 9 cases, by genital endometriosis in 7 cases, and by hypergonadotropic hypogonadism in 2 cases. One of the patients underwent IVF procedure twice in 4 years. All T2D patients received prepregnancy care including weight loss, diabetes compensation, diabetes complications treatment, and, if necessary, a transfer to insulin therapy and insulin treatment education for 1-2 months before entering into the IVF protocol. Angiotensin-converting enzyme inhibitors and statins should be stopped if they were prescribed in case of hypertension or dyslipidemia and other medications allowed during pregnancy should be started. 26 women (51%) did not take periconceptional multivitamin supplementation before IVF procedure. The level of glycated hemoglobin (HbA1c) in this group was 6.4 ± 0.5%. 25 patients (49%) underwent incomplete preparation for pregnancy before entering into the IVF protocol but not in full. An important stage of prepregnancy care was weight loss in women with overweight and obesity. The duration of a prepregnancy care program varied from 2 to 6 months and on average was 3.8 ± 1.7 months. The mean HbA1c level in this group was 5.8 ± 0.4%. All cases of IVF pregnancies in women with T2D resulted with live birth. The incidence of preeclampsia, cesarean section delivery, and preterm labor was lower in the group of women who had been given prepregnancy care. Conclusion. Proper prepregnancy care including weight loss, diabetes compensation, early start of insulin therapy, and diabetes complications treatment before conception is an effective method of preventing perinatal complications in women with T2D.