18. Absence of the corpus luteum in early pregnancy increases the risk of preeclampsia.

Introduction Assisted reproductive technology is associated with an increased risk of preeclampsia, but the reasons are poorly understood. The corpus luteum (CL) produces multiple vasoactive hormones in the first trimester of pregnancy which could affect initial placentation and later development of preeclampsia. Hypothesis We hypothesized that non-physiologic states present in in-vitro fertilization (IVF) such as absence of the CL could increase the risk of preeclampsia. Methods 892 infertile women were enrolled in this prospective cohort study. Four categories based on CL status were defined: (1) absence of the CL; (2) single CL; (3) multiple CL associated with ovulation induction; (4) multiple CL associated with controlled ovarian stimulation for IVF and fresh embryo transfer. Analysis focused on singleton pregnancies conceived with autologous oocytes resulting in live birth (n = 683). Multivariable logistic regression was used to control for covariates. Results Compared with conceptions occurring in the presence of one CL, conceptions occurring in the absence of a CL were associated with a higher incidence of preeclampsia (12.8% vs 4.8%, P = 0.02) and preeclampsia with severe features (9.6% vs 1.4%, P = < 0.001). Compared with FET occurring in the presence of one CL (modified natural cycles), FET occurring in the absence of a CL (programmed cycles) were associated with a higher incidence of preeclampsia (12.8% vs 3.9%, P = 0.02) and preeclampsia with severe features (9.6% vs 0.8%, P = 0.002). Absence of CL and programmed FET were predictive in multivariable regression models for preeclampsia (OR 2.73; 1.14–6.49 and 3.55; 1.20–11.94) and preeclampsia with severe features (6.45; 1.94–25.09 and 15.05; 2.59–286.27) compared to presence of one CL or FET in a natural cycle. Discussion Among singleton pregnancies after infertility resulting in live birth, those conceived in the absence of a CL were at increased risk for development of preeclampsia and preeclampsia with severe features. [ABSTRACT FROM AUTHOR]