Fertility issues and pregnancy outcomes in Turner syndrome
Dedicated multidisciplinary management of pregnancy in Turner syndrome, preconception, during pregnancy, and in the postpartum period, optimizes the chances of a successful and uncomplicated pregnancy in this high-risk population.
Volume 114, Issue 1, Pages 144–154
Matilde Calanchini, M.D., Christina Y.L. Aye, D.Phil., Elizabeth Orchard, F.R.C.P., Kathy Baker, B.Sc.(Hons.), Tim Child, M.D., Andrea Fabbri, Prof., Lucy Mackillop, M.A., Helen E. Turner, M.D.
To study fertility issues and pregnancy outcomes in Turner syndrome (TS).
Retrospective cohort study.
One hundred fifty-six TS patients, median age 32 years, 23 mosaic 45,X/46,XX, 45,X/47,XXX, 45,X/46,XX/47,XXX.
Main Outcome Measure(s)
Fertility choices, spontaneous pregnancy, and oocyte donation (OD) outcomes. Conditions associated with aortic dissection and poor pregnancy outcomes at preconception were considered. Pregnancy-related aortic dimension changes and the long-term impact of pregnancy on TS-related comorbidities were assessed.
In all, 13.5% had spontaneous pregnancies, resulting in a pregnancy with live birth in 18 patients (37 newborns); 16% considered OD, one adopted, and one underwent fertility preservation.
Spontaneous pregnancy predictive factors were a karyotype with a second or third cell line with more than one X and spontaneous menarche. In all, 47.6% had miscarriages, two experienced preeclampsia, and two had gestational diabetes. One daughter was diagnosed with TS in adulthood.
Seven of 14 who attempted OD had a pregnancy with live birth; two of seven had gestational diabetes; 64.3% attempting OD had risk factors associated with poor pregnancy outcomes, including four who had double embryo transfer. Cardiac status at preconception was evaluated in 12 of 25 women who had a pregnancy. The aortic diameters during pregnancy increased. The aortic growth at sinuses was 0.51 ± 0.71 mm/year and at ascending aorta 0.67 ± 0.67 mm/year, reaching a significant difference at sinuses compared with the growth in nulliparous TS. Among women who had a pregnancy, none experienced aortic dissection during and in the years after pregnancy.
This study highlights the importance of a TS-dedicated multidisciplinary management of pregnancy, before and during pregnancy and in the postpartum period.