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Gestational diabetes prevalence and outcomes in women undergoing assisted reproductive techniques (ART)
Prevalencia y resultados de la diabetes gestacional en mujeres sometidas a técnicas de reproducción asistida (TRA)
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Consequently, use of assisted reproductive techniques (ART) is required by many couples. Pregnancies after ART are generally associated with worse prognosis, including more gestational diabetes mellitus (GDM), but it has not been clear whether this should be attributed to confounding factors, including maternal age, maternal BMI or multiple pregnancies.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1–6</span></a> Factors related to the cause of infertility, drugs used for ovulation induction and luteal phase support as well as the hormonal environment after ovulation and early pregnancy could be associated with the increase in GDM in these patients.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4,7</span></a> A potential worsening of underlying metabolic and vascular factors exacerbated during ART procedures could also be responsible for the increased rate of GDM. Ashrafi et al. found that type of ART and progesterone use for luteal support<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> influenced the risk for GDM, but others did not.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">GDM is a controversial disorder without universal consensus with regards to diagnostic criteria and many different guidelines coexist.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">9–11</span></a> The World Health Organization-International Association for Diabetes in Pregnancy Study Group (WHO-IADPSG) criteria defined after the HAPO study, have been endorsed by different entities (WHO, International Federation of Gynaecology and Obstetrics [FIGO]) but not by others (the American College of Obstetricians and Gynecologists [ACOG], National Institute for Health and Care Excellence [NICE]). WHO criteria diagnose GDM in a single step: a 75<span class="elsevierStyleHsp" style=""></span>g oral glucose tolerance test (OGTT) performed in the second trimester and requires only one glucose value above 92, 182 or 153<span class="elsevierStyleHsp" style=""></span>mg/dl at 0–60 or 120<span class="elsevierStyleHsp" style=""></span>min respectively for the diagnosis. In Spain, the Gestational Diabetes group of the National Diabetes Society recommends the classic two-step diagnostic protocol: first the O'Sullivan test and if ≥140<span class="elsevierStyleHsp" style=""></span>mg/dl, a 100<span class="elsevierStyleHsp" style=""></span>g OGTT interpreted with National Diabetes Data Group (NDDG) criteria (two above: 0<span class="elsevierStyleHsp" style=""></span>h ≥105<span class="elsevierStyleHsp" style=""></span>mg/dl, 1<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>190<span class="elsevierStyleHsp" style=""></span>mg/dl, 2<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>165<span class="elsevierStyleHsp" style=""></span>mg/dl, 3<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>145<span class="elsevierStyleHsp" style=""></span>mg/dl); a change towards IADPSG criteria has not been recommended based on a national study since it would increase the rates of GDM and the pressure on the Public Health System without scientific evidence of clear benefit with intervention.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">12,13</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Among the studies that have found an increased rate of GDM in ART pregnancies, most of them have used IADPSG criteria for the diagnosis or ADIPS (Australasian Diabetes in Pregnancy Society) in Australian studies.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,2,6–8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We aimed to investigate whether women that underwent ART at our Hospital had a higher incidence of GDM than women who conceived spontaneously. Another objective was to analyse if ART was related to the GDM rate and if the type of ART influenced that rate. We also aimed to evaluate the rate of second trimester fasting plasma glucose (FPG)<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg/dl – as an approximation to WHO diagnostic criteria for GDM – according to ART and the rate of complications and obstetrical outcomes in women who developed GDM in both groups.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a retrospective analysis of prospectively collected data of all consecutive singleton pregnancies (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>29,529) attended at Hospital Universitari Dexeus between January 2008 and December 2019, who had complete data for all the main variables included in this study. Patients younger than 18 years, with pregestational diabetes, patients treated with metformin prior to pregnancy and multiple pregnancies were excluded. Only patients who were followed-up and delivered at our hospital were included. Informed consent was obtained from all patients and the reported investigations were carried out in accordance with the principles of the Declaration of Helsinki as revised in 2008.</p><p id="par0030" class="elsevierStylePara elsevierViewall">All patients were managed according to standardised clinical protocols, homogeneous in terms of GDM screening and management throughout the study period, following the Spanish Diabetes Society-Diabetes and Pregnancy Group-recommendations.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> Screening for GDM was universal in the second trimester and targeted according to risk factors in the first trimester. Diagnosis was based on the two-step protocol: after an O'Sullivan test ≥140<span class="elsevierStyleHsp" style=""></span>mg/dl, a 100<span class="elsevierStyleHsp" style=""></span>g OGTT was performed. GDM was diagnosed according to NDDG criteria: two or more above: 105, 190, 165 and 145<span class="elsevierStyleHsp" style=""></span>mg/dl at baseline, 1, 2 and 3<span class="elsevierStyleHsp" style=""></span>h respectively after oral glucose.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Ovarian stimulation protocols have been previously described elsewhere. Briefly, ovarian stimulation was performed under gonadotrophins and pituitary suppression with gonadotrophin-releasing hormone analogues (agonists or antagonists) according to established protocols.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> Standard hormonal replacement protocol<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a> was used for endometrial preparation in frozen embryo transfer (FET) and oocyte donor receptors (ODR).</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Data collection</span><p id="par0040" class="elsevierStylePara elsevierViewall">Clinical and biochemical data were prospectively collected throughout pregnancy and entered in standard computerised clinical records used in posterior statistical analysis. Demographics, smoking status, history of prior conditions and obstetric outcomes as well as physical examination data were collected at the first antenatal visit. The BMI was calculated as the weight in kg divided by the square height in metres (m<span class="elsevierStyleSup">2</span>). All patients were managed according to homogenous standardised clinical protocols.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Outcomes</span><p id="par0045" class="elsevierStylePara elsevierViewall">Main outcomes were rate of GDM defined by NDDG criteria, rate of second trimester FPG<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg/dl – as an approximation of GDM by WHO criteria – and rate of maternal and foetal complications in both groups: ART and non-ART patients with GDM.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Maternal outcomes included: primary caesarean delivery and gestational hypertensive disease (GHD) (including gestational hypertension and preeclampsia). Preeclampsia was defined as systolic blood pressure ≥140<span class="elsevierStyleHsp" style=""></span>mmHg or diastolic blood pressure ≥90<span class="elsevierStyleHsp" style=""></span>mmHg on ≥2 measures ≥6<span class="elsevierStyleHsp" style=""></span>h apart and proteinuria of ≥1+ on a dipstick test or a 24-h urine protein ≥300<span class="elsevierStyleHsp" style=""></span>mg. Gestational hypertension was diagnosed when the criteria for elevated blood pressure were met without proteinuria.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Perinatal outcomes included small for gestational age (SGA) (defined as birth weight below the 10th percentile for gestational age), macrosomia (defined as neonatal weight at or above 4000<span class="elsevierStyleHsp" style=""></span>g), large for gestational age (defined as birth weight above 95th percentile), prematurity (defined as gestational age at delivery<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>37.0 weeks), severe prematurity (defined as gestational age at delivery<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>34.0 weeks) and Apgar score<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>7 at 1 and 5<span class="elsevierStyleHsp" style=""></span>min.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Gestational age was defined as completed weeks based on last menstrual period or on the earliest ultrasound assessment if discordant.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Subtypes of ART were considered for group analysis: IVF/ICSI, frozen embryo transfer (FET), oocyte donor recipients (ODR) and inseminations.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation (SD), were reported for continuous variables, and number and percentage were reported for categorical variables (% (<span class="elsevierStyleItalic">n</span>)).</p><p id="par0075" class="elsevierStylePara elsevierViewall">Categorical variables were compared using the chi-square test or the Fisher exact. Continuous variables were compared using the Student's <span class="elsevierStyleItalic">T</span> test. Finally, to explore if ART was associated with the rate of GDM a multivariable logistic regression (LR) model was also constructed to analyse possible predictors of GDM including maternal age, BMI at the first antenatal visit and parity.</p><p id="par0080" class="elsevierStylePara elsevierViewall">All tests were bilateral with a significant level set to 5%. The statistical analysis was performed using IBM® SPSS® Statistics v22.0 and R (R Development Core Team, 2008) software.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">A total of 29,529 patients were included in the study with a mean age of 34.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.3 years and mean BMI of 23.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.8<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, 96.6% were Caucasian and 9% smokers. Pregnancy was achieved by means of ART in 2596 women (8.8%): 852 IVF/ICSI (32.8%), 980 FET (37.7%), 446 ODR (17.2%) and 318 inseminations (12.2%). The rest (26,933) were spontaneous pregnancies (91.2%).</p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Clinical characteristics</span><p id="par0090" class="elsevierStylePara elsevierViewall">Characteristics of women in the spontaneous pregnancy and ART groups are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. As expected, women's age (38.49<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.71 vs 34.61<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) and nulliparity (77.8% vs 56.7%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) were higher in the ART group compared with the spontaneous pregnancy group. Significant differences in pregnancy weight gain were found between the ART and spontaneous pregnancy groups (11.41<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.11 vs 12.18<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.04, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). However, we found no differences in the pre-pregnancy BMI between the two groups. Smoking habit (5.8% vs 9.3%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) and previous C-section (4.8% vs 6.8%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) were less common in the ART group.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Rates of GDM by NDDG criteria</span><p id="par0095" class="elsevierStylePara elsevierViewall">The GDM global rate was 8.9% (2632). If we compare the different study groups, the GDM rate was 12.7% (330) in pregnancies by ART compared to 8.5% (2302) in non-ART pregnancies (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). According to the ART subtypes, GDM was 11.2% (95) in the subgroup of IVF/ICSI, 17.7% (79) in ODR, 13% (127) FET and 9.1% (29) in the insemination group (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001).</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Rates of second trimester FPG<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg/dl</span><p id="par0100" class="elsevierStylePara elsevierViewall">Overall, 8.8% (815) of patients had FPG<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg/dl, 11.9% (104) in the ART group and 8.5% (711) in the spontaneous pregnancy group (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001). In the DMG group 20.7% of the ART pregnancies had FPG<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg/dl and 15.5% of spontaneous pregnancies (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Multivariable analysis</span><p id="par0105" class="elsevierStylePara elsevierViewall">In a multivariable analysis adjusted by confounding factors (maternal age, BMI and parity), we observed that ART was not an associated factor for GDM [OR 1.03 (0.90–1.19)] (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">We built a model (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) to report the probability of GDM in mean age, adjusted by BMI and ART, in nulliparous and multiparous women.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Pregnancy outcomes in GDM patients in ART vs non-ART</span><p id="par0115" class="elsevierStylePara elsevierViewall">Pregnancy outcomes were similar in both groups except for C-section rates. There were no differences in GHD, SGA, LGA, preterm<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>34 GW or <37 GW, Apgar score or macrosomia rates in both groups. C section rates were 30.0% in ART patients versus 15.9% in non-ART (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">The present study provides epidemiological data and pregnancy outcomes in a large population of pregnant patients by means of ART (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2596) compared to spontaneous pregnancies (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>26,933). Rates of GDM were much higher in ART patients (12.7% vs 8.5%) but in multivariable analysis, ART was not associated with this outcome. We also found significant differences in GDM rates between different ART subtypes: IVF/ICSI, FET, ODR and inseminations but these groups were not comparable in variables known to affect GDM rates.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Pregnancy outcomes were similar between GDM in spontaneous and ART pregnancies except for C-section, suggesting that ART does not confer an additional risk for the other complications of GDM studied.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Pregnancies after assisted reproduction are thought to be associated with worse prognosis than spontaneous pregnancies, including more GDM,<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6–8</span></a> but it has not been clear to date whether this is due to confounding factors, including age or twin pregnancies; studies have also used different diagnostic criteria for GDM. The present study is based on a very large cohort of pregnant women from a single University Hospital followed by a homogeneous protocol, criteria for GDM diagnosis was based on the two-step protocol, the 100<span class="elsevierStyleHsp" style=""></span>g OGTT and the NGGD cut-offs. We found an increased rate of GDM in ART but the multivariable analysis does not support any influence, and other factors including age, BMI and parity seem to explain the differences among ART versus the non-ART groups.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Different authors have assessed GDM rates in patients undergoing ART. Different studies have used different GDM diagnostic criteria and reported rates of GDM are different, probably accordingly to that. Some authors have found ART to be independently related to GDM but many studies are cross-sectional and retrospective<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,6</span></a> and many did not exclude multiple pregnancies or patients with prior metformin use as we did. These variables may have influenced our findings. Other large studies lack clinically relevant information and/or did not control for clinically relevant confounding factors.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">16,17</span></a> Silberstein et al.,<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> in a large cohort including pregnancies conceived by IVF (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1296) and ovulation induction (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1988) as compared to singletons conceived spontaneously (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>172,288), found a significant linear association among the three groups for GDM (17.3% in IVF, 14.2% in ovulation induction and 6.6% in the control group), severe preeclampsia (2.7% in IVF, 1.8% in ovulation induction, 1.1% in the control group) and overall perinatal mortality (3.3% in IVF, 2.1% in ovulation induction and 1.3% in the control group). In the multivariable analysis, both IVF and ovulation induction treatments were found to be independent risk factors for GDM. In this particular study GDM rates were similar to ours, though GDM diagnostic criteria were not specified.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Carbillon et al.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> found a greater rate of GDM after ART than after spontaneous pregnancies (17.6% vs 14.2%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). They also found a higher prevalence of GDM after ovulation induction followed by assisted-reproduction procedures (18.3%) than after ovulation induction only (15.5%). Upon multivariable analysis, women who had ART compared with those who had spontaneous pregnancies or pregnancies after ovulation induction only, had a higher risk of gestational diabetes with an odds ratio of 1.32 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05).</p><p id="par0145" class="elsevierStylePara elsevierViewall">The present study also aimed to understand the prognosis of assisted-reproduction pregnancies with gestational diabetes. We found a similar prognosis of GDM independent of ART, except for C-Section. Carbillon et al.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> found higher rates of GDM (by WHO criteria) and more obstetric complications in ART, but this was mainly driven by polycystic ovarian syndrome (PCOS), a population that in the present study was less represented since metformin use prior to pregnancy was an exclusion criterion, and PCOS patients in our hospital are usually on metformin prior to conception. Koukhan et al.,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> in a nested case-control study with a more limited number of patients, found higher complications of GDM (by WHO criteria) in women who had ART versus spontaneous pregnancies. It is also possible that NDDG criteria and WHO criteria identify different subtypes of GDM (more baseline hyperglycaemia in those by WHO criteria) and this may be another factor related to the different results.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Other authors have also found worse obstetric results in ART pregnancies.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,17,20</span></a> Shevell et al.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> reported pregnancy outcomes in a cohort of 36,062 pregnancies, 1776 (4.9%) by means of ART, separating those who had IVF vs. ovulation induction in the ART group. Ovulation induction was associated with a statistically significant increase in placental abruption, foetal loss after 24 weeks, and although gestational diabetes was increased, it did not meet criteria for achieving statistical significance after adjustment. Use of IVF was associated with a statistically significant increase in preeclampsia, gestational hypertension, placental abruption, placenta previa, and risk of caesarean delivery but they did not report complications in the GDM groups only.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Limitations of the present study include the retrospective nature of data analysis, the lack of some clinical information like family history of diabetes and as our hospital is a private institution it may be a bias in the population included in the study, but its strengths are the large sample and the homogeneity of care of the population included.</p><p id="par0160" class="elsevierStylePara elsevierViewall">In conclusion: Despite a higher prevalence of GDM in ART pregnancies, ART was not associated with an increased risk of GDM when adjusting for age, parity and BMI. The prognosis of GDM in patients undergoing ART is similar to those with spontaneous pregnancies except for C-section rates.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Authors’ contributions</span><p id="par0165" class="elsevierStylePara elsevierViewall">GS, PP and MA: substantially contributed to the design, review and interpretation of the results. SG and IR: carried out a lot of work by performing all the statistical analysis. IR and MG: significantly contributed by collecting data and writing some parts of the main document. BS and ARM: as a senior consultant, substantially contributed to the final review of the study. GA and PP: main authors, both first authors of the article. Developed the idea of the study, collected data, wrote a major part of the manuscript and reviewed all the documents for submission. All authors have read and approved the manuscript.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Availability of data and materials</span><p id="par0170" class="elsevierStylePara elsevierViewall">All data generated or analysed during this study are included in this published article. Supplementary information files are also available on request.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Consent for publication</span><p id="par0175" class="elsevierStylePara elsevierViewall">Not applicable.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Funding</span><p id="par0180" class="elsevierStylePara elsevierViewall">No funding was received for this study.</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflict of interests</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare that they have no competing interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres1803582" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:1 [ "identificador" => "abst0005" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aims" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1576490" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1803583" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:1 [ "identificador" => "abst0030" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1576489" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Data collection" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Outcomes" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Clinical characteristics" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Rates of GDM by NDDG criteria" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Rates of second trimester FPG > 92 mg/dl" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Multivariable analysis" ] 4 => array:2 [ "identificador" => "sec0055" "titulo" => "Pregnancy outcomes in GDM patients in ART vs non-ART" ] ] ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "Authors’ contributions" ] 9 => array:2 [ "identificador" => "sec0070" "titulo" => "Availability of data and materials" ] 10 => array:2 [ "identificador" => "sec0075" "titulo" => "Consent for publication" ] 11 => array:2 [ "identificador" => "sec0080" "titulo" => "Funding" ] 12 => array:2 [ "identificador" => "sec0085" "titulo" => "Conflict of interests" ] 13 => array:2 [ "identificador" => "xack636379" "titulo" => "Acknowledgments" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-09-21" "fechaAceptado" => "2021-11-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1576490" "palabras" => array:6 [ 0 => "Gestational diabetes" 1 => "Pregnancy" 2 => "Assisted reproductive techniques" 3 => "Obstetric outcomes" 4 => "Perinatal morbidity" 5 => "C-section rates" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1576489" "palabras" => array:6 [ 0 => "Diabetes gestacional" 1 => "Embarazo" 2 => "Técnicas de reproducción asistida" 3 => "Resultados obstétricos" 4 => "Morbilidad perinatal" 5 => "Tasas de cesáreas" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Infertility affects millions worldwide and use of assisted reproductive techniques (ART) is in high demand.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Aims</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To investigate whether women that underwent ART at our hospital had a higher incidence of GDM than women who conceived spontaneously, if the ART subtype affects the GDM rate and to study obstetrical outcomes in women with GDM in both groups.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This was a retrospective analysis of prospectively collected data of singleton pregnancies attended at Hospital Universitari Dexeus between 2008 and 2019. Age<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>18 years, pregestational diabetes, metformin prior to pregnancy and multiple pregnancies were excluded.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A total of 29,529 patients were included. Pregnancy was achieved by ART in 2596 (8.8%): in vitro fertilisation (IVF/ICSI) 32.8%, frozen embryo transfer (FET) 37.7%, oocyte donor receptors (ODR) 17.2% and insemination 12.2%. The GDM rate was 8.9% (12.7% in ART vs 8.5% in non-ART, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). The GDM was 11.2% in IVF/ICSI, 17.7% in ODR, 13% in FET and 9.1% in the insemination group (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001). In a multivariable analysis adjusting for age, parity and BMI, ART was not associated with GDM [OR 1.03 (0.90–1.19)], nor was type of ART. Pregnancy outcomes in GDM patients were similar in both groups except for C-section rates (30.0% in ART vs 15.9% in non-ART (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Despite a higher prevalence of GDM in ART pregnancies, ART was not associated with an increased risk of GDM when adjusting for age, parity and BMI. The prognosis of GDM in ART and non-ART was similar except for C-section rates.</p></span>" "secciones" => array:5 [ 0 => array:1 [ "identificador" => "abst0005" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aims" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La infertilidad afecta a millones de personas en todo el mundo y existe una gran demanda de técnicas de reproducción asistida (TRA).</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Investigar si las mujeres sometidas a TRA en nuestro hospital presentaron una mayor incidencia de diabetes mellitus gestacional (DMG) que aquellas que concibieron espontáneamente, conocer si el subtipo de TRA afecta a la tasa de DMG y estudiar los resultados obstétricos en mujeres con DMG en ambos grupos.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se trató de un análisis retrospectivo de datos recogidos prospectivamente de los embarazos únicos atendidos en el Hospital Universitari Dexeus entre 2008 y 2019. Los criterios de exclusión fueron <18 años, diabetes pregestacional, uso de metformina antes del embarazo o embarazo múltiple.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Se incluyó a un total de 29 529 pacientes. El embarazo se logró mediante TRA en 2596 (8,8%): fecundación in vitro (FIV/ICSI) 32,8%, transferencia de embriones congelados (TEC) 37,7%, receptoras de óvulos donados (ROD) 17,2% e inseminación 12,2%. La tasa de DMG fue del 8,9% (un 12,7% en pacientes sometidas a TRA, frente al 8,5% en pacientes no sometidas a TRA, p <0,001). Se observó una tasa de DMG del 11,2% en el grupo con FIV/ICSI, del 17,7% en el grupo con ROD, del 13% en el grupo con TEC y del 9,1% en el grupo con inseminación (p = 0,001). En un análisis multivariable ajustado por edad, número de partos e IMC, la TRA no se asoció a DMG (OR 1,03 [0,90--1,19]), ni tampoco el tipo de TRA. Los desenlaces de los embarazos en las pacientes con DMG fueron similares en ambos grupos, excepto en las tasas de cesáreas (un 30,0% en pacientes sometidas a TRA frente al 15,9% en pacientes no sometidas a TRA) (p < 0,001).</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">A pesar de una mayor prevalencia de DMG en los embarazos logrados con una TRA, esta no se asoció a un mayor riesgo de DMG cuando se ajustó por edad, número de partos o IMC. El pronóstico de la DMG en pacientes sometidas a una TRA fue similar al de aquellas pacientes no sometidas a una TRA, excepto por las tasas de cesáreas.</p></span>" "secciones" => array:5 [ 0 => array:1 [ "identificador" => "abst0030" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2359 "Ancho" => 2341 "Tamanyo" => 218585 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Probability of GDM in age mean, adjusted by BMI and ART, in nulliparous and multiparous.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">ART: assisted reproductive techniques; BMI: body mass index.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Spontaneous pregnancies (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>26,933) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="5" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ART pregnancies</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"><span class="elsevierStyleItalic">P</span> value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Global ART (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2596) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IVF/ICSI (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>852) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FET (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>980) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ODR (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>446) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">INS (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>318) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean maternal age (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.61<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.49<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.86<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.12<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.47<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.31<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a><0.001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.07<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.20<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.83<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.22<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.86<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.23<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.093<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a><0.001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weight gain (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.18<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.41<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.74<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.36<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.84<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.55<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a>0.003<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smoking %(<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.3% (2209) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.8% (148) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.3% (61) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.6% (45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.9% (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.1% (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a>0.107<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Parity (Nulliparous) %(<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.7% (15,278) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77.8% (2020) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.6% (721) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.6% (692) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79.1% (353) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79.9% (254) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a><0.001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous C-section %(n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.8% (1828) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.8% (125) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.7% (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.8% (67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.3% (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.0% (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a>0.001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><span class="elsevierStyleItalic">P</span> value between spontaneous pregnancies vs global ART.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "**" "nota" => "<p class="elsevierStyleNotepara" id="npar0010"><span class="elsevierStyleItalic">P</span> value between different subgroups in ART.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Characteristics of women in the spontaneous group and ART pregnancies.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Glu: glucose; LGA: large for gestational age; SGA: small for gestational age; IUGR: intrauterine growth restriction; ART: assisted reproductive techniques; FET: frozen-thawed embryo transfer; IVF: in vitro fertilisation; ins: insemination.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Spontaneous pregnancies %(<span class="elsevierStyleItalic">n</span>)8.5 (2302) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total ART pregnancies%(<span class="elsevierStyleItalic">n</span>)12.7 (330) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glu<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.5 (137/885) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.7 (30/145) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.075 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elective C-section \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.9 (367) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.0 (99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GHD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.2 (74) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.2 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.072 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SGA ( \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.5 (172) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.5 (28/) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.289 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IUGR ( \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.3 (30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.3 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.084 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preterm delivery<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.7 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.095 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preterm delivery<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.6 (106) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.7 (22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.103 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Apgar 5<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.2 (4/2273) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.3 (1/326) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.459 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Apgar 1<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6 (36/2275) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.1 (7/327) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.489 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Macrosomia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.7 (108) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.5 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.906 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LGA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.8 (272) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.335 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Pregnancy outcomes in GDM patients in ART vs non-ART.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">ART: assisted reproductive techniques; BMI: body mass index; CI: confidence interval; OR: odds ratio; GDM: gestational diabetes.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maternal age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[1.07; 1.10] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[1.07; 1.09] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Parity (nulliparity) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[1.21; 1.45] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[0.90; 1.19] \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">GDM multivariant logistic regression adjusted by maternal age, BMI, parity and assisted reproductive techniques.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. 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Comstock" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.AOG.0000183593.24583.7c" "Revista" => array:8 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "2005" "volumen" => "106" "numero" => "Pt 1" "paginaInicial" => "1039" "paginaFinal" => "1045" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16260523" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0161642016001470" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack636379" "titulo" => "Acknowledgments" "texto" => "<p id="par0190" class="elsevierStylePara elsevierViewall">This study has been carried out under the auspices of the Càtedra d’Investigació en Obstetrícia i Ginecologia of the Autonomous University of Barcelona, Spain</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/25300164/0000006900000010/v1_202211180721/S2530016422000271/v1_202211180721/en/main.assets" "Apartado" => array:4 [ "identificador" => "63844" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Originales" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25300164/0000006900000010/v1_202211180721/S2530016422000271/v1_202211180721/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016422000271?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 1 | 6 |
| 2024 October | 42 | 7 | 49 |
| 2024 September | 56 | 38 | 94 |
| 2024 August | 46 | 25 | 71 |
| 2024 July | 33 | 15 | 48 |
| 2024 June | 42 | 15 | 57 |
| 2024 May | 37 | 21 | 58 |
| 2024 April | 32 | 13 | 45 |
| 2024 March | 48 | 13 | 61 |
| 2024 February | 64 | 11 | 75 |
| 2024 January | 41 | 7 | 48 |
| 2023 December | 55 | 6 | 61 |
| 2023 November | 57 | 9 | 66 |
| 2023 October | 82 | 6 | 88 |
| 2023 September | 26 | 1 | 27 |
| 2023 August | 48 | 1 | 49 |
| 2023 July | 25 | 6 | 31 |
| 2023 June | 19 | 4 | 23 |
| 2023 May | 8 | 2 | 10 |
| 2023 April | 8 | 1 | 9 |
| 2023 March | 7 | 6 | 13 |
| 2023 February | 27 | 6 | 33 |
| 2023 January | 7 | 6 | 13 |
| 2022 December | 7 | 8 | 15 |
| 2022 November | 6 | 7 | 13 |
| 2022 October | 0 | 7 | 7 |
| 2022 September | 0 | 6 | 6 |
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