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A sonographic endometrial thickness <7 mm in women undergoing in vitro fertilization increases the risk of placenta accreta spectrum - 04/04/24

Doi : 10.1016/j.ajog.2024.02.301 
Siying Lai, BSMed a, Lizi Zhang, MD a, Yang Luo, MS a, b, Zhongjia Gu, BSMed a, Zhenping Yan, BSMed a, Yuliang Zhang, BSMed a, Yingyu Liang, MS a, Minshan Huang, MS a, Jingying Liang, BSMed a, Shifeng Gu, BSMed a, Jingsi Chen, MD a, Lei Li, PhD a, b, , Dunjin Chen, MD, PhD a, , Lili Du, PhD a,
a Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangzhou, China 
b the Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Provice, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China 

Corresponding authors: Lili Du, PhD.Lei Li, PhD.Dunjin Chen, MD, PhD.
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 04 April 2024

Abstract

Background

The prevalence of placenta accreta spectrum, a potentially life-threatening condition, has exhibited a significant global rise in recent decades. Effective screening methods and early identification strategies for placenta accreta spectrum could enable early treatment and improved outcomes. Endometrial thickness plays a crucial role in successful embryo implantation and favorable pregnancy outcomes. Extensive research has been conducted on the impact of endometrial thickness on assisted reproductive technology cycles, specifically in terms of pregnancy rates, live birth rates, and pregnancy loss rates. However, limited knowledge exists regarding the influence of endometrial thickness on placenta accreta spectrum.

Objective

This study aimed to evaluate the association between preimplantation endometrial thickness and the occurrence of placenta accreta spectrum in women undergoing assisted reproductive technology cycles.

Study Design

A total of 4637 women who had not undergone previous cesarean delivery and who conceived by in vitro fertilization or intracytoplasmic sperm injection–embryo transfer treatment and subsequently delivered at the Third Affiliated Hospital of Guangzhou Medical University between January 2008 and December 2020 were included in this study. To explore the relationship between endometrial thickness and placenta accreta spectrum, we used smooth curve fitting, threshold effect, and saturation effect analysis. Multivariate logistic regression analysis was performed to evaluate the independent association between endometrial thickness and placenta accreta spectrum while adjusting for potential confounding factors. Propensity score matching was performed to reduce the influence of bias and unmeasured confounders. Furthermore, we used causal mediation effect analysis to investigate the mediating role of endometrial thickness in the relationship between gravidity and ovarian stimulation protocol and the occurrence of placenta accreta spectrum.

Results

Among the 4637 women included in this study, pregnancies with placenta accreta spectrum (159; 3.4%) had significantly thinner endometrial thickness (non–placenta accreta spectrum, 10.08±2.04 mm vs placenta accreta spectrum, 8.88±2.21 mm; P<.001) during the last ultrasound before embryo transfer. By using smooth curve fitting, it was found that changes in endometrial thickness had a significant effect on the incidence of placenta accreta spectrum up to a thickness of 10.9 mm, beyond which the effect plateaued. Then, the endometrial thickness was divided into the following 4 groups: ≤7, >7 to ≤10.9, >10.9 to ≤13, and >13 mm. The absolute rates of placenta accreta spectrum in each group were 11.91%, 3.73%, 1.35%, and 2.54%, respectively. Compared with women with an endometrial thickness from 10.9 to 13 mm, the odds of placenta accreta spectrum increased from an adjusted odds ratio of 2.27 (95% confidence interval, 1.33–3.86) for endometrial thickness from 7 to 10.9 mm to an adjusted odds ratio of 7.15 (95% confidence interval, 3.73–13.71) for endometrial thickness <7 mm after adjusting for potential confounding factors. Placenta previa remained as an independent risk factor for placenta accreta spectrum (adjusted odds ratio, 11.80; 95% confidence interval, 7.65–18.19). Moreover, endometrial thickness <7 mm was still an independent risk factor for placenta accreta spectrum (adjusted odds ratio, 3.91; 95% confidence interval, 1.57–9.73) in the matched cohort after PSM. Causal mediation analysis revealed that approximately 63.9% of the total effect of gravidity and 18.6% of the total effect of ovarian stimulation protocol on placenta accreta spectrum were mediated by endometrial thickness.

Conclusion

The findings of our study indicate that thin endometrial thickness is an independent risk factor for placenta accreta spectrum in women without previous cesarean delivery undergoing assisted reproductive technology treatment. The clinical significance of this risk factor is slightly lower than that of placenta previa. Furthermore, our results demonstrate that endometrial thickness plays a significant mediating role in the relationship between gravidity or ovarian stimulation protocol and placenta accreta spectrum.

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Lai. The relationship between endometrial thickness and placenta accreta spectrum in women receiving assisted reproductive treatment. Am J Obstet Gynecol 2024.

Le texte complet de cet article est disponible en PDF.

Key words : endometrial thickness, gravidity, ovarian stimulation protocol, placenta accreta spectrum


Plan


 S.L., L.Z., and Y.L. share first authorship.
 This work was supported by the National Key R&D Program of China (No. 2022YFC2704503 and 2022YFC2704501), the National Natural Science Foundation of China (No. 82071652, 82371674, 82171666, and 81830045), the General Program of the Guangdong Natural Science Fund (No. 2021A1515011039 and 2022A1515012405), the Basic and Applied Basic Research Foundation of the Guangzhou Basic Research Program (No.202102010055), and the Project of Administration of Traditional Chinese Medicine of Guangdong Province of China (No.20222126).
 Cite this article as: Lai S, Zhang L, Luo Y, et al. A sonographic endometrial thickness <7 mm in women undergoing in vitro fertilization increases the risk of placenta accreta spectrum. Am J Obstet Gynecol 2024;XX:x.ex–x.ex.


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