Diabetes and prediabetes are increasingly prevalent in women of reproductive age and may affect fertility outcomes. Data regarding the impact of pre-treatment glycemic control on assisted reproductive technology (ART) live birth rates are limited.
To examine whether glycemic control, assessed by HbA1C and fasting plasma glucose levels before ART, differs between women whose treatment resulted in live birth and those whose treatment did not.
This retrospective case–control study included women with pregestational diabetes or prediabetes treated at Kaplan Medical Center, Rehovot, between January 2014 and April 2024. Clinical and demographic data, laboratory results, and ART outcomes were collected. The primary outcome was the comparison of glycemic control between live birth and non-live birth groups. Secondary outcomes included obstetric and neonatal complications.
17 women undergoing a total of 44 ART cycles met the inclusion criteria. Live birth occurred in 17 cycles (38.6%). Fasting glucose prior to treatment was significantly higher in the live birth group compared to the no live birth group (115± 14.3 vs. 102.19 ± 15.08 mg/dL,p = 0.008). HbA1C levels did not differ significantly (6.28 ± 0.65 vs. 6.08 ± 0.45,p = 0.244). Obstetric complications among live birth pregnancies included preterm birth (23.53%), large-for-gestational-age infants (41.18%), and high cesarean delivery rate (76.47%).
Fasting glucose, but not HbA1C, was associated with ART live birth outcomes in women with diabetes and prediabetes. The high complication rates highlight the importance of close monitoring and tailored management in this population.
Shani Erez BMSc, Tal Schiller MD, Alena Kirzhner MD and Yuval Or MD
8 – 15
Invasive coronary angiography (ICA) remains the gold standard for coronary artery disease (CAD) diagnosis but involves procedural risks. Stress single-photon emission computed tomography (SPECT) myocardial perfusion is a promising non-invasive alternative, with currently limited diagnostic yield.
We aimed to identify clinical factors associated with an agreement between stress SPECT MPI and ICA results and combine them with SPECT MPI to enhance its diagnostic value.
We retrospectively analyzed 915 patients with suspected CAD who underwent stress SPECT followed by ICA within three months (2019–2020). Clinical, demographic, and imaging data were extracted from medical records. Variables associated with diagnostic agreement were identified using univariate logistic regression. A predictive model combining SPECT results with clinical variables was developed using backward stepwise logistic regression and evaluated by AUC-ROC.
Of the 915 patients included, 230 (25.14%) had a positive SPECT result and a negative ICA result, and 61 (6.67%) had a negative SPECT result and a positive ICA result. We identified associations [OR (95% CI)] between tests’ agreement and use of nitrates [3.18 (1.31, 7.73)], antiplatelets [2.57(1.86, 3.56)], chronic renal failure [2.34 (1.43, 3.84)], type II diabetes [1.78 (1.28, 2.48)] female sex [0.50 (0.34, 0.73)], smoking [0.72 (0.50, 1.03)], and increased BMI [0.95 (0.92, 0.99)]. The predictive model we developed achieved an accuracy of 74.39%, with an AUC-ROC of 0.72 (95% CI 0.68–0.76), compared with 0.54 (95% CI 0.50–0.59) for SPECT alone.
Common clinical factors are associated with an agreement between SPECT and ICA in the diagnosis of CAD. Incorporating these factors alongside SPECT results improves the noninvasive diagnostic yield.
Matan Danon BSc, Nitzan Shabat Cohen BSc, Saar Ashri MPH , Yehuda Warszawer BSc, Yonathan Hasin MD
17 – 26
Mitral valve prolapse (MVP) is the most common valvular abnormality in women of reproductive age and is associated with an increased risk of arrhythmias and sudden cardiac death. Data on arrhythmic risk during pregnancy and puerperium in women with MVP remain limited.
The aim of this study was to evaluate the incidence of arrhythmias in pregnant women with MVP and to identify structural and clinical factors associated with arrhythmic events during pregnancy and puerperium.
Single-center retrospective study conducted on women with MVP who delivered at Tel Aviv Medical Center between 1997 and 2024. Clinical, electrocardiographic and imaging data were collected before, during, and after pregnancies and puerperium. Patients were grouped according to arrhythmia status: no arrhythmias, arrhythmias outside of pregnancy/puerperium, or arrhythmias during pregnancy/puerperium.
103 women with MVP were initially identified, of which 44 met inclusion criteria. Overall, arrhythmias occurred in nine patients (20%), including three (7%) during pregnancy or puerperium. Compared with patients without arrhythmias, those with arrhythmias during pregnancy had significantly higher rates of mitral annulus disjunction (100%vs. 31%), myxomatous degeneration (67% vs. 11%), moderate or greater mitral regurgitation (67% vs. 19%), and larger left atrial and ventricular dimensions. No life-threatening events occurred during pregnancy or puerperium.
Our findings suggest a benign course of pregnancy and puerperium in most women with MVP. Nevertheless, cardiac structural features might be associated with an increased arrhythmic risk.
Jamie Felstein, Sheizaf Gefen MD MPH, Tammy Jacoby MD, Bar Frumer, Yoav Granot MD, Lior Zornitzki MD,Shir Frydman MD, Nir Flint MD, Michal Laufer Perl MD, Shmuel Banai MD, Yan Topilsky MD, Ofer Havakuk MD
28 – 35
