Endocrine Abstracts

Aims: Oocyte donation (OD) is increasingly utilised in women with Turner’s syndrome (TS). However, guidelines state TS a ‘relative contraindication’ for pregnancy, due to increased risk of aortic dissection (AD 2%) and maternal mortality (2%). Recent data on OD-related morbidity and mortality in TS has raised further concern. We aimed to analyse cardiovascular risk profiles of TS women undergoing OD and those with spontaneous pregnancy (SP), and determine outcomes in a setting of rigorous peri-pregnancy monitoring by a multidisciplinary team.

Methods: Of 104 women seen at a dedicated multidisciplinary TS clinic, 14 had SP (3/14 45XO) and 6 OD (3/6 45XO). Cardiovascular risk factors, aortic sinuses (AS) and ascending aorta (AA) measurements, maternal and fetal morbidity and mortality were analysed.

Results: There were 26 successful pregnancies (3 from OD). Baseline features in SP vs OD were: age at pregnancy 24±6 years vs 35±4 years (P<0.001); hypertension 15% vs 66% (P<0.05); bicuspid aortic valve 23% vs 50% (P<0.05); AS 1.69±0.17 cm/m² vs 2.02±0.41 cm/m² (P<0.05); AA 1.50±0.22 vs 2.04±0.44 cm/m² (P<0.01). There were no differences in BMI 27.6±3.1 vs 29.0±6.4, comorbidities 21% vs 66%, or previous aortic surgery 8% vs 17%. Post-pregnancy aortic dimensions were: AS 1.70±0.23 (SP) vs 2.16±0.48 (OD, P<0.05) and AA 1.58±0.22 vs 2.10±0.61 (P<0.05), but Δ increase was not significant (AS: Δ 0.07±0.14 vs 0.10±0.16; AA: Δ 0.03±0.11 vs −0.02±0.27, P=ns). There were no cases of AD, pre-eclampsia or maternal mortalities. Delivery was at 39±1 week vs 38±0 weeks (P=ns), with caesarean deliveries in 77% vs 100% (P=ns) and one still-birth (SP).

Conclusions: Women with TS undergoing OD were older and had more cardiovascular risk factors. However, pregnancy outcomes were comparable to the SP group with minimal maternal complications and excellent survival. Rigorous risk-assessment, peri-pregnancy monitoring and follow-up by a specialist multidisciplinary team can result in safe and successful outcomes in these women.