Assisted Reproductive Technology Associated With An Increased Risk Gestational Diabetes

Assisted Reproductive Technology Associated With An Increased Risk Gestational Diabetes

While assisted reproductive technology (ART) has been around for quite some time, it’s now more common than ever.

According to the annual report from the Society of Assisted Reproductive Technology, in 2013 a record number of women utilised IVF.

Because ART has become more common and been used for a while, researchers have been able to look at whether there are any short and long term effects.

Assisted Reproductive Technology Associated With An Increased Risk Gestational Diabetes

A recent study in France has found that women who use ART are at a greater risk for developing gestational diabetes (GD).

While researchers have long known ART is associated with poorer prognosis than naturally conceived pregnancies, they haven’t able to figure out if it was due to the ART itself or other factors such as an increased number of multiples or maternal age.

While some places routinely screen all mothers for GD, some countries such as France only screen mothers with risk factors.

Researchers now believe women that utilise ART need to be screened for GD regardless of whether they meet the other risk factors.

So, why are women that utilise ART at a greater risk for developing GD?

Research Unclear About ART Association With GD

The French study included 18,305 women who gave birth between 2002 and 2010. Women who used ART made up 3.3% (453 women) of the total cohort. Women who underwent IVF, ovulation-induction, transfers or intracytoplasmic sperm injection were included in the ART group.

The mean BMI of study participants was 24 kg/m², mean age was 30 years, and 58.8% had at least one risk factor for gestational diabetes. The study seems to represent typical pregnant mothers. They also adjusted for factors such as being overweight, a family history of diabetes, hypertension, multiples and other factors.

What they found was a clear increased risk in GD among women utilising ART. Women that conceived without assistance had a GD rate of 14.2%, while women in the ART group had a rate of 17.6%.

The prevalence of gestational diabetes was 15.5% after ovulation induction, higher than women not utilising ART but not as drastic as those also needing an assisted reproduction procedure which was 18.3%.

However, even with a clear increased risk, there’s uncertainty about the exact reason.

Possible Reasons ART Is Linked With GD

Women needing assistance to conceive are more likely to have underlying health concerns or be considered advanced maternal age (over 35). Thyroid conditions, polycystic ovarian syndrome (PCOS) and being overweight can make conceiving more difficult and are also risk factors for gestational diabetes.

Polycystic ovarian syndrome (PCOS) is a common health concern that includes insulin resistance. Having PCOS increases one’s risk of gestational diabetes and Type 2 diabetes. PCOS increases the risk of eventually developing diabetes by 50%.

It’s possible that the underlying health causes of fertility problems are the real reason there’s an increased risk of GD during a pregnancy that results from ART.

Researchers found that of the women that developed GD, they were more likely to be overweight, have a history of miscarriage, have a history of GD or a family history of diabetes.

GD Following ART Isn’t Worse Than GD In A Naturally Conceived Pregnancy

While there is an increased risk of developing GD, the prognosis related to GD – as assessed by birth weight of at least 4 kg, preeclampsia, and shoulder dystocia — isn’t worse in an ART pregnancy.

Study author Dr Cosson noted: “Prognosis appears to be similar or even better after ovulation induction and assisted reproduction than after natural pregnancies.”

What Does This Information Mean?

While gestational diabetes is a relatively common pregnancy ailment, it is a serious health concern – especially when left untreated. In places where GD screening isn’t routine, it’s important for women with risk factors as well as those who have used ART to be properly screened for GD.

It’s also suggested women be tested for diabetes before undergoing ART. They should be screened early on, rather than waiting until the second or even third trimester.

When GD is well managed, the prognosis for mother and baby is often good. When GD isn’t well managed there are increased health risks for both mother and baby.

For women planning to utilise ART, it’s a good idea to reduce any risk factors that are within their control. While changing family history or age isn’t possible, healthy lifestyle choices might help to reduce their risk of developing GD. A healthy BMI, remaining active and a healthy whole foods diet might reduce the risk of developing GD.

A preventative GD friendly diet, one low in processed grains and sugars, might also be helpful for women planning to use ART. Preparing for ART with lifestyle changes may even aid in success of conceiving as many women report lifestyle changes helped keep their PCOS symptoms at bay.

We may not know the exact cause, but it’s clear that women utilising ART are at an increased risk of GD. While science still works to find the answer, it’s important that women and their doctors screen properly for GD and act accordingly to keep mother and baby healthy.

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Maria Silver Pyanov is a mama of four energetic boys and one unique little girl. She is also a doula and childbirth educator. She's an advocate for birth options, and adequate prenatal care and support. She believes in the importance of rebuilding the village so no parent feels unsupported.

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