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Uterine Artery Pulsatility Index in Singleton Pregnancies Conceived via Assisted Reproductive Technology Versus
Antonios Siargkas1, Ioannis Tsakiridis1, Areti Faka1
1Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
Assisted reproductive technology (ART) pregnancies show lower uterine artery pulsatility index (UtA-PI) values, indicating better placental perfusion. However, ART pregnancies face a higher risk of preeclampsia (PE), suggesting other factors contribute to PE development.
Area of Science:
- Reproductive Medicine
- Maternal-Fetal Medicine
- Obstetrics
Background:
- Uterine artery pulsatility index (UtA-PI) is a key biomarker for placental function.
- Clinical interpretation of UtA-PI in assisted reproductive technology (ART) pregnancies remains uncertain.
- ART pregnancies are associated with increased risks of perinatal complications.
Purpose of the Study:
- To compare trimester- and method-specific UtA-PI differences between ART and spontaneous conceptions (SC).
- To examine the association between UtA-PI and risks for preeclampsia (PE) and small-for-gestational-age (SGA) neonates in ART pregnancies.
- To contextualize UtA-PI findings within ART pregnancy outcomes.
Main Methods:
- Systematic literature search of MEDLINE, Scopus, and Cochrane Library up to June 25, 2025.
- Inclusion of observational studies comparing UtA-PI and perinatal outcomes in singleton ART versus SC pregnancies.
- Meta-analysis using random-effects models to calculate standardized mean differences (SMD) and risk ratios (RR), with quality assessment using Newcastle-Ottawa Scale and QUIPS tool.
Main Results:
- ART pregnancies exhibited significantly lower first (SMD = -0.28) and second trimester (SMD = -0.20) UtA-PI values compared to SC.
- Lower UtA-PI values were driven by oocyte donation and artificial cycle frozen embryo transfers (ET).
- ART pregnancies had an elevated overall risk for PE (RR = 2.32), particularly with oocyte donation (RR = 6.11) and artificial cycle frozen ET (RR = 3.45).
Conclusions:
- ART pregnancies, especially those from oocyte donation and artificial cycle frozen ET, demonstrate lower UtA-PI values.
- Despite lower UtA-PI, ART pregnancies face a significantly elevated risk for PE, indicating mechanisms beyond placental perfusion.
- ART method is an independent risk factor for PE, necessitating adjusted UtA-PI interpretation and further research into underlying pathophysiology.
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