Incidence of pulmonary and venous thromboembolism in pregnancies after in vitro fertilisation: cross sectional study

Abstract

Objective To estimate the risk of pulmonary embolism and venous thromboembolism in pregnant women after in vitro fertilisation.Design Cross sectional study. Setting Sweden.Participants 23 498 women who had given birth after in vitro fertilisation between 1990 and 2008 and 116 960 individually matched women with natural pregnancies.Main outcome measures Risk of pulmonary embolism and venous thromboembolism (identified by linkage to the Swedish national patient register) during the whole pregnancy and by trimester.

Failure of fertility therapy and subsequent adverse cardiovascular events

“…10,11 Prior population-based reports of women receiving fertility therapy (including in vitro fertilization) indicated an increased risk of pulmonary embolism throughout pregnancy, post partum 10,11 and over subsequent years. 12 An increased risk of thrombosis persists after the birth of a child conceived with the help of fertility therapy and may extend to women following fertility therapy failure.…”

“…In addition, fertility therapy may lead to adverse cardiovascular events by inducing background thrombosis, activating the renin-angiotensin system or inducing vascular injury from ovarian hyperstimulation. [8][9][10][11][12][13][14][15][16] The last mechanism may be further exacerbated in patients who undergo multiple cycles of fertility therapy or experience pregnancy miscarriages. [17][18][19][20][21] An association between fertility therapy failure and longterm cardiovascular risk could provide insight into nontraditional risk factors potentially contributing to the stagnation in the reduction of cardiovascular mortality observed among young women.…”

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

“…Абсо лютное число женщин, перенесших ТЭЛА, в обеих Тромбоэмболия легочной артерии: клинические рекомендации Европейского общества кардиологов (2014) 528 Пульмонология. 2015; 25 (5): 525-552 группах было низким (3,0 случая vs 0,4 случая на 10 000 беременных в I триместре и 8,1 случая vs 6,0 случая на 10 000 беременных в целом) [24]. У женщин в постменопаузе, которые получают заместительную гормонотерапию, риск ВТЭ широко варьируется в зависимости от используемого препарата [25].…”

“…В поперечном исследова нии, выполненном на основе шведского регистра, общий риск ТЭЛА (по сравнению с риском у жен щин такого же возраста, которые родили 1 го ребен ка без использования экстракорпорального оплодо творения) особенно возрастает во время I триместра беременности (отношение рисков неблагоприят ного исхода -hazard ratio (HR) -6,97; 95% ный доверительный интервал (ДИ) -2,21-21,96). Абсо лютное число женщин, перенесших ТЭЛА, в обеих группах было низким (3,0 случая vs 0,4 случая на 10 000 беременных в I триместре и 8,1 случая vs 6,0 случая на 10 000 беременных в целом) [24]. У женщин в постменопаузе, которые получают заместительную гормонотерапию, риск ВТЭ широко варьируется в зависимости от используемого препарата [25].…”

Prevention and management of ovarian hyperstimulation syndrome

“…Although there are no comparative studies addressing the value of thromboprophylaxis in women with severe OHSS, the use of prophylactic low molecular weight heparin (LMWH) prophylaxis is supported by the increased incidence of first trimester thrombosis in women with OHSS (16.8 VTE events per 1000 women, OR 99.7, 95% CI 61.6-161.1) as compared to non-IVF pregnancies (0.2 VTE events per 1000 women) [30]. Thrombosis in women with OHSS frequently affects upper body sites, and clinicians should remain vigilant of patients presenting with unusual symptoms such as dizziness, loss of vision and neck pain [31]. With respect to duration of prophylaxis, the increased VTE risk may extend beyond the first trimester, and consequently thromboprophylaxis should be considered at least until the end of the first trimester, with further treatment decided in conjunction with a specialist haematologist [3].…”