Assisted reproductive technology and hypertensive disorders of pregnancy: systematic review and meta-analyses

Abstract

Background Hypertensive disorders of pregnancy (HDP) is one of the most common pregnancy complications and causes of maternal morbidity and mortality. Assisted reproductive technology (ART) has been associated with adverse pregnancy outcomes, including HDP. However, the impact of multiple pregnancies, oocyte donation, as well as fresh and frozen embryo transfer needs to be further studied. We conducted a systematic review and meta-analyses to evaluate the association between ART and HDP or preeclampsia relative to spontaneous conception (SC). Methods We identified studies from EMBASE, MEDLINE, and Cochrane Library (up to April 8, 2020) and manually using structured search strategies. Cohort studies that included pregnancies after in vitro fertilization (IVF) with or without intracytoplasmic sperm fertilization (ICSI) relative to SC with HDP or preeclampsia as the outcome of interest were included. The control group was women who conceived spontaneously without ART or fertility medications. The pooled results were reported in odds ratios (OR) with 95% confidence intervals based on random effects models. Numbers needed to harm (NNH) were calculated based on absolute risk differences between exposure and control groups. Results Eighty-five studies were included after a screening of 1879 abstracts and 283 full text articles. Compared to SC, IVF/ICSI singleton pregnancies (OR 1.70; 95% CI 1.60–1.80; I2 = 80%) and multiple pregnancies (OR 1.34; 95% CI 1.20–1.50; I2 = 76%) were both associated with higher odds of HDP. Singleton pregnancies with oocyte donation had the highest odds of HDP out of all groups analyzed (OR 4.42; 95% CI 3.00–6.51; I2 = 83%). Frozen embryo transfer resulted in higher odds of HDP (OR 1.74; 95% CI 1.58–1.92; I2 = 55%) than fresh embryo transfer (OR 1.43; 95% CI 1.33–1.53; I2 = 72%). The associations between IVF/ICSI pregnancies and SC were similar for preeclampsia. Most interventions had an NNH of 40 to 100, while singleton and multiple oocyte donation pregnancies had particularly low NNH for HDP (16 and 10, respectively). Conclusions Our meta-analysis confirmed that IVF/ICSI pregnancies are at higher odds of HDP and preeclampsia than SC, irrespective of the plurality. The odds were especially high in frozen embryo transfer and oocyte donation pregnancies.

Caesarean birth in women with infertility: population‐based cohort study

“…Infertility, with or without IT, is known to be associated with several adverse pregnancy outcomes that heighten the risk of CS, such as pre‐eclampsia, gestational diabetes, small‐for‐gestational age, and preterm labour 3–7 . Advanced maternal age and obesity are recognised risk factors for infertility, 23,24 and both are associated with a higher risk of CS 25,26 .…”

“…Access to infertility treatment (IT) in Canada is on the rise, 2 and has been covered under Ontario’s public health plan since 2015. Infertility, with or without IT, may result in adverse pregnancy outcomes and higher rates of birth by caesarean section (CS) 3–8 . About 1/4 to 1/3 births in Canada are by CS 9 .…”

“…Infertility, with or without IT, may result in adverse pregnancy outcomes and higher rates of birth by caesarean section (CS). 3 , 4 , 5 , 6 , 7 , 8 About 1/4 to 1/3 births in Canada are by CS. 9 CS is the most common in‐patient surgery, 10 with a high cost to the healthcare system.…”

Effects of early maternal cancer and fertility treatment on the risk of adverse birth outcomes

“… 45 , 46 Higher risks for pregnancy complications, including gestational diabetes mellitus, hypertension, and preeclampsia, have also been reported in women achieving a pregnancy after ART as well as in pregnant survivors of early-onset cancer. 47 , 48 , 49 , 50 , 51 Thus, pregnancy complications might also contribute to the increased risk of preterm births or lower birth weight observed in our study.…”

Maternal-Perinatal Variables in Patients with Severe Preeclampsia Who Develop Acute Kidney Injury

“…To date, we have not found any studies that that relate AKI to the use of assisted reproductive techniques in patients with SP, although there are studies that describe the relationship between AKI and assisted reproduction techniques in pregnant women in general [ 29 , 30 ]. What is well established is that preeclampsia is the most frequent cause of AKI in developed countries [ 13 , 21 , 23 , 24 , 31 , 32 ], and it is very likely that the established relationship between preeclampsia and assisted reproductive techniques justifies our results [ 33 , 34 , 35 , 36 ].…”