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Infertility treatments raise risk of vascular and pregnancy complications

Women opting for fertility treatment have a higher risk of vascular and pregnancy-related complications, especially if they are 35 or older, a UK study has found.

The British research found that woman using assisted reproductive technology to fall pregnant had a 2.5 times higher risk of acute kidney failure and a 65% higher risk for an irregular heartbeat. They also had a 57% higher risk of placental abruption, when the placenta separates from the inner wall of the uterus before birth. And they were also 38% more likely to need a Caesarean delivery, and 26% more likely to have the baby born prematurely.

“Advancing maternal age, specifically being 35 and older, increases the risk of having or developing conditions like chronic high blood pressure, which increase the risk of pregnancy complications,” said study author Dr Pensée Wu, senior lecturer and honorary consultant obstetrician and subspecialist in maternal foetal medicine at Keele University School of Medicine in Staffordshire.

The study, which was published in the Journal of the American Heart Association, compared more than 106,000 deliveries in which the baby was conceived with assisted reproductive technology, with more than 34 million births conceived without such aid.

Women who used infertility treatments had more preexisting health conditions, such as high blood pressure and diabetes, and were more likely to be obese when they started treatment, the study found.

A limitation was that the study did not compare different fertility treatments, which is an “important distinction”, said Chicago reproductive endocrinology and infertility specialist Dr Sigal Klipstein, who was not involved in the study.

“A woman requiring a short course of fertility pills to conceive and a woman requiring multiple cycles of IVF (in vitro fertilisation) were all lumped together in this study,” said Klipstein, a liaison member of the American College of Obstetricians and Gynaecologists’ Committee on Ethics.

“There may be significant differences between groups based on type of fertility treatment, length of treatment, and time between treatment and conception,” she said.

There were increased risks for women who underwent fertility treatments even when they had no preexisting symptoms of heart disease, the study also found.

“We were surprised that assisted reproductive technology was independently associated with these complications, as opposed to being associated with only the existence of pre-existing health conditions or only among older women undergoing infertility treatment,” Wu said.

That finding did not surprise Klipstein. “It is often the underlying infertility, and not the fertility treatment, that is associated with worse outcomes.”

She pointed to PCOS, or polycystic ovary syndrome, a common hormonal disorder in women. It’s a leading cause of infertility and also carries an increased lifetime risk of cardiovascular disease. Women with PCOS are seven times more likely to suffer a heart attack, she said.

“According to the current study, one in five women enter pregnancy with a history of cardiovascular risk factors,” Klipstein said, which can raise health risks for the woman as she carries and delivers her child.

In her view, Klipstein said the main message of the study is the need for women to address any risk factors for heart disease before falling pregnant, if that is possible. They can focus on losing weight, lowering high blood pressure and getting their cholesterol under control, she said.

“The take home message is that physicians should counsel all women with preexisting cardiovascular risk factors, who might fall pregnant, about pregnancy-related risks, whether or not they have a history of infertility,” she added.

Study details
In‐Hospital Complications in Pregnancies Conceived by Assisted Reproductive Technology

Pensée Wu, Garima Sharma, Laxmi Mehta, Carolyn Chew‐Graham, Gina Lundberg, Kara Nerenberg, Michelle Graham, Lucy Chappell, Umesh Kadam, Kelvin Jordan, Mamas A. Mamas.

Published in Journal of the American Heart Association on 22 February 2022

Abstract

Background
Assisted reproductive technology (ART) has emerged as a common treatment option for infertility, a problem that affects an estimated 48 million couples worldwide. Advancing maternal age with increasing prepregnancy cardiovascular risk factors, such as chronic hypertension, obesity, and diabetes, has raised concerns about pregnancy complications associated with ART. However, in‐hospital complications following pregnancies conceived by ART are poorly described.

Methods and Results
To assess the patient characteristics, obstetric outcomes, vascular complications and temporal trends of pregnancies conceived by ART, we analysed hospital deliveries conceived with or without ART between January 1, 2008, and December 31, 2016, from the United States National Inpatient Sample database. We included 106 248 deliveries conceived with ART and 34 167 246 deliveries conceived without ART. Women who conceived with ART were older (35 versus 28 years; P<0.0001) and had more comorbidities. ART‐conceived pregnancies were independently associated with vascular complications (acute kidney injury: adjusted odds ratio [aOR], 2.52; 95% CI 1.99–3.19; and arrhythmia: aOR, 1.65; 95% CI, 1.46–1.86), and adverse obstetric outcomes (placental abruption: aOR, 1.57; 95% CI, 1.41–1.74; cesarean delivery: aOR, 1.38; 95% CI, 1.33–1.43; and preterm birth: aOR, 1.26; 95% CI, 1.20–1.32), including in subgroups without cardiovascular disease risk factors or without multifetal pregnancies. Higher hospital charges ($18 705 versus $11 983; P<0.0001) were incurred compared with women who conceived without ART.

Conclusions
Pregnancies conceived by ART have higher risks of adverse obstetric outcomes and vascular complications compared with spontaneous conception. Clinicians should have detailed discussions on the associated complications of ART in women during prepregnancy counseling.

 

Journal of the American Heart Association article – In‐Hospital Complications in Pregnancies Conceived by Assisted Reproductive Technology (Open access)

 

CNN article – Infertility treatments raise risk of heart and pregnancy complications, study finds (Open access)

 

See more from MedicalBrief archives:

 

'Trading on hope’ — Fertility clinics exploit older women

 

Major gaps in education and support for women with PCOS

 

Pregnancy complications link to heightened risk of later CVD — Umbrella review

 

 

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