Assisted reproductive technology and pregnancy-related hypertensive complications: a systematic review

Abstract

Hypertensive complications in pregnancy are the leading cause of maternal morbidity, at least in the developed countries. In recent years, infertility issues are managed with ever growing therapeutic options namely assisted reproductive technologies (ART), which improve the ratio of successful induction of pregnancy. It is still debated whether various ART modalities are associated with adverse pregnancy outcomes, including hypertensive complications, particularly with higher incidence of preeclampsia. The main source of controversy stems from the diversity of effect modifiers modulating the association between ART-oriented pregnancy and hypertensive disorders. Indeed, women undergoing an ART procedure are affected by diverse causes of infertility, are frequently characterized by different genetic patterns with respect to their artificially conceived embryo and experienced multiple gestations. In order to investigate whether ART modalities are associated with increased incidence of hypertensive complications in pregnancy, we reviewed all published studies carried out before the end of 2010 and identified in the PubMed database. Among the 47 studies finally selected and by acknowledging the potential of shortcomings related to the different study design and populations, the overall evidence suggests that ART-oriented pregnancies-especially the in-vitro fertilization techniques-are accompanied by increased risk for gestational hypertension and preeclampsia as compared with non-ART pregnancies, even after adjustment for confounders. Multiple gestations, advanced age and underlying polycystic ovary syndrome resulted in constant confounders of the questioned association. Reducing multiple gestations by implementing single embryo techniques might be the therapeutic limiting step to lower the rate of hypertensive complications in assisted pregnancies.

Comparison of obstetric outcomes of pregnancies after donor oocyte IVF: Three-arm age-matched retrospective cohort study

“…Perinatal outcome (Table 5) including mean birth weight, APGAR score, incidence of SFD, hyperbilirubinemia and respiratory distress was significantly higher in donor oocyte group as compared to spontaneous conception group (p=0.001) but outcomes including mean birth weight, APGAR score, respiratory distress, congenital anomaly did not suggest any significant variation between the donor and self-oocyte IVF cycles (P>0.05). 17 Thomopoulos showed that ART pregnancies, especially IVF techniques, are accompanied by increased risks for gestational hypertension as compared with non-ART pregnancies, even after adjustment for confounding factors. 17 The success of pregnancy depends upon an appropriate implantation and placental function.…”

“…17 Thomopoulos showed that ART pregnancies, especially IVF techniques, are accompanied by increased risks for gestational hypertension as compared with non-ART pregnancies, even after adjustment for confounding factors. 17 The success of pregnancy depends upon an appropriate implantation and placental function. 18 The risk of hypertensive disorders of pregnancy in DO pregnancies can be explained on the basis of an immunological mechanism.…”

Pregnancy and cardiovascular risk: A review focused on women with heart disease undergoing fertility treatment

“…Multiple pregnancies are frequent in ART usage: the incidence of twins in in vitro fertilisation (IVF)-conceived pregnancies is approximately 27%. 3 The extent to which women are able to cope with the haemodynamic challenges imposed by pregnancy, particularly multiple pregnancies, depends on the nature, severity and current status of the underlying heart condition. 7 Despite the broad morphological and functional diversity of heart disease, only a few parameters have been shown to be associated with complications in pregnancy: previous cardiac events (heart failure, transient ischaemic attack or stroke before pregnancy) or arrhythmia; poor functional New York Heart Association (NYHA) class (>II) or cyanosis; LV systolic dysfunction (ejection fraction <30%); left heart obstruction; and pulmonary arterial hypertension.…”

“…3 Although data are inconsistent, FTs have been linked to PIH. 1,3,29,30 In their systematic review, Thomopoulos et al analysed 47 studies and found that ARTs, and IVF in particular, are associated with an increased risk of gestational hypertension and pre-eclampsia. 3 Multiple pregnancies and advanced maternal age further increase the risk of hypertensive complications.…”

“…1 In the largest European countries (Germany, France, the United Kingdom and Italy) 1.7-2.2% of births are conceived through fertility treatments (FTs). 1 Today, there is a higher demand for these technologies, [1][2][3] as well as a trend towards delayed childbearing over recent decades. 2,4 Furthermore, with older maternal age at the time of first pregnancy, the risk of cardiovascular diseases increases owing to the greater prevalence of risk factors such as hypertension and diabetes.…”