Infertility Treatments Bring New Babies — But Also More Risks to New Moms
— Obstetric, vascular complications of delivering babies conceived with versus without ART
by Nicole Lou, Staff Writer, MedPage Today February 22, 2022
Pregnant women who conceived with assisted reproductive technology (ART) were prone to more pregnancy and vascular complications upon delivery, a large nationwide study found.
According to the U.S. National Inpatient Sample (NIS) database, hospital deliveries of babies conceived by ART, instead of spontaneous conception, were independently associated with:
- Maternal acute kidney injury: 38 vs 9 per 10,000 deliveries (adjusted OR 2.52, 95% CI 1.99-3.19)
- Maternal arrhythmia: 143 vs 74 per 10,000 deliveries (adjusted OR 1.65, 95% CI 1.46-1.86)
- Placental abruption: 200 vs 107 per 10,000 deliveries (adjusted OR 1.57, 95% CI 1.41-1.74)
- Cesarean delivery: 5,489 vs 3,211 per 10,000 deliveries (adjusted OR 1.38, 95% CI 1.33-1.43)
- Preterm birth: 1,433 vs 624 per 10,000 deliveries (adjusted OR 1.26, 95% CI 1.20-1.32)
Adverse obstetric and vascular outcomes were more frequent in women with cardiovascular disease (CVD) risk factors in particular, reported Pensée Wu, MBChB, MD(Res) of Keele University in Staffordshire, England, and colleagues.
« Although the absolute risk remains low, our study highlights the need for close monitoring of both obstetric and vascular complications during admission for delivery in women who conceived with ART, particularly in those with CVD risk factors …
Primary and specialist care clinicians should ensure that they communicate these risks and how to mitigate them, » Wu’s group wrote in the Journal of the American Heart Association.
The increased obstetric and vascular risks associated with ART were observed in both singleton and multifetal pregnancies.
« Derangements in the renin-angiotensin-aldosterone axis and endothelial dysfunction in ART have been suggested to contribute to increased CVD risk.
This may be a contributory cause for our finding of increased risk of vascular complications in the ART group, » the authors suggested.
« Nevertheless, it remains challenging to determine whether the increased prevalence of adverse outcomes is attributable to the ART procedure itself or maternal factors associated with infertility or is multifactorial, » they acknowledged.
The study analyzed hospital deliveries conceived with or without ART from 2008 to 2016.
The NIS yielded a sample of more than 7.2 million that was extrapolated to represent over 34.2 million delivery hospitalizations.
Of these, 0.31% were said to have relied on ART for conception.
Over time, the proportion of ART-associated deliveries had increased from 0.05% in 2008 to 0.51% in 2016.
Women who conceived with ART were older, wealthier, more likely to have multifetal pregnancy and current pre-eclampsia or eclampsia, and had a higher prevalence of congenital heart disease, dyslipidemia, valvular disease, and obesity.
Hospital charges for delivery tended to be higher in ART-associated pregnancies (median $18,705 vs $11,983 for women who conceived without ART, P<0.0001).
Investigators observed no significant excesses in ischemic stroke, peripartum cardiomyopathy, or venous thromboembolism during delivery of ART-associated pregnancies.
The retrospective study was inherently limited by the potential for exposure misclassification, ascertainment bias, and underreporting of secondary diagnoses, Wu’s group cautioned.
The authors also could not adjust for potential confounders such as the type of ART used before conception and the medications taken by the mother.
« Future research should examine the impact of optimization of cardiovascular risk factors before ART on pregnancy complications and long-term cardiovascular health, » they stated.
Wu disclosed support from a National Institute for Health Research Transitional Research Fellowship.
Journal of the American Heart Association