Risk of hypertensive disorders in pregnancy following assisted reproductive technology: overview and meta‐analysis

Thomopoulos, Costas; Salamalekis, George; Kintis, Konstantinos; Andrianopoulou, Iliana; Michalopoulou, Helena; Skalis, George; Archontakis, Stefanos; Argyri, Ourania; Tsioufis, Costas; Makris, Thomas; Salamalekis, E.

doi:10.1111/jch.12945

Cited by 43 publications

(34 citation statements)

References 26 publications

(42 reference statements)

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“…In a twins study, Fox et al ( 318 ) found, on adjusted analysis, that the egg donation independently associated with PE (aOR 2.409, CI 1.051–5.524). The meta-anaysis of Thomopoulos et al ( 319 ) gave a risk ratio for egg donation of 3.60 (CI 2.56–5.05) over controls, a value similar to that of Blázquez et al ( 320 ). Finally, a recent meta-analysis by Masoudian et al ( 313 ) found that that the risk of PE is considerably higher in oocyte-donation pregnancies compared to other methods of assisted reproductive technology (OR, 2.54; CI 1.98–3.24; P < 0.0001) or to natural conception (OR, 4.34; CI 3.10–6.06; P < 0.0001).…”

Section: Evidence From Epidemiology—semen Can Be Protective Against Psupporting

confidence: 67%

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Immunological Tolerance, Pregnancy, and Preeclampsia: The Roles of Semen Microbes and the Father†

Kenny

Kell

2018

Front. Med.

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Although it is widely considered, in many cases, to involve two separable stages (poor placentation followed by oxidative stress/inflammation), the precise originating causes of preeclampsia (PE) remain elusive. We have previously brought together some of the considerable evidence that a (dormant) microbial component is commonly a significant part of its etiology. However, apart from recognizing, consistent with this view, that the many inflammatory markers of PE are also increased in infection, we had little to say about immunity, whether innate or adaptive. In addition, we focused on the gut, oral and female urinary tract microbiomes as the main sources of the infection. We here marshall further evidence for an infectious component in PE, focusing on the immunological tolerance characteristic of pregnancy, and the well-established fact that increased exposure to the father’s semen assists this immunological tolerance. As well as these benefits, however, semen is not sterile, microbial tolerance mechanisms may exist, and we also review the evidence that semen may be responsible for inoculating the developing conceptus (and maybe the placenta) with microbes, not all of which are benign. It is suggested that when they are not, this may be a significant cause of PE. A variety of epidemiological and other evidence is entirely consistent with this, not least correlations between semen infection, infertility and PE. Our view also leads to a series of other, testable predictions. Overall, we argue for a significant paternal role in the development of PE through microbial infection of the mother via insemination.

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Section: Evidence From Epidemiology—semen Can Be Protective Against Psupporting

confidence: 67%

“…Thomopoulos et al carried out two detailed and systematic reviews ( 319 , 332 ); the latter ( 319 ) covered 7,038,029 pregnancies (203,375 following any invasive ART) and determined that the risk of PE was increased by 75% (95% CI 50–103%).…”

Section: Evidence From Epidemiology—semen Can Be Protective Against Pmentioning

confidence: 99%

Immunological Tolerance, Pregnancy, and Preeclampsia: The Roles of Semen Microbes and the Father†

Kenny

Kell

2018

Front. Med.

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“…Third, the information of assisted reproductive technology pregnancies (ref. 34 ) and a history of sleep apnea (ref. 35 ) were not available in the present study; therefore, it should be cautious when generalizing the findings.…”

Section: Discussionmentioning

confidence: 99%

Association between hypertensive disorders of pregnancy and the risk of postpartum hypertension: a cohort study in women with gestational diabetes

et al. 2017

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Previous studies in general people indicated that hypertensive disorders of pregnancy (HDP) increased the risk of subsequent hypertension after delivery. Some studies found that women with gestational diabetes mellitus (GDM) had an increased risk of HDP. However, very few studies have assessed the association between HDP and the risk of postpartum hypertension among GDM women. To evaluate the association between HDP and the risk of postpartum hypertension among GDM women, a retrospective cohort study was conducted in 1261 women with prior GDM at their postpartum 1–5 years using the baseline data from Tianjin Gestational Diabetes Mellitus Prevention Program. Cox regression models were applied to assess the single and joint associations of having a history of HDP, maternal pre-pregnancy Body mass index (BMI) (normal weight, overweight and obesity), and weight change from preconception to post-delivery with the risk of subsequent hypertension among the GDM women. We found that GDM women with a history of HDP, high pre-pregnancy BMI and weight gain more than 7 kg from preconception to post-delivery had an increased risk of postpartum hypertension. Joint effects analysis revealed that the positive association between a history of HDP in the index pregnancy and the risk of postpartum hypertension was consistent in GDM women with different levels of pre-pregnancy BMI or weight gain from preconception to post-delivery. In conclusion, a history of HDP, high pre-pregnancy BMI and weight gain more than 7 kg from preconception to post-delivery increase the risk of subsequent hypertension in postpartum 1–5 years among GDM women.

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“…A large retrospective stratified analysis of ART (596,520 mothers; 30.6% ART mothers) indicated that multiple pregnancies after ART are the single most likely explanation for the increased rate of gestational hypertension or preeclampsia among ART mothers [83]. More recently, a meta-analysis including 66 longitudinal studies (7,038,029 pregnancies; 203,375 following any ART) found that all pregnancy-related hypertensive disorders, independent of gestation order, were increased following any invasive ART [+54% (95% CI: 39%-70%), gestational hypertension +79% (95% CI: 24%-157%), and preeclampsia +75% (95% CI: 50%-103%)] [84].…”

Section: Assisted Reproductive Technologies (Art)mentioning

confidence: 99%

Hypertension and Reproduction

et al. 2020

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Purpose of Review Many aspects of reproduction have been associated with increased blood pressure and impaired glucose metabolism that reveals a subsequent increased risk of cardiovascular disease. The aim of this review is to assess reproductive life factors associated with an increased risk of hypertension and cardiovascular disease, e.g., early life programming, sexual, and reproductive health in men and women. Recent Findings Impaired fetal growth, with low birth weight adjusted for gestational age, has been found associated with hypertension in adulthood. Erectile dysfunction, currently considered an early diagnostic marker of cardiovascular disease preceding the manifestation of coronary artery disease by several years, frequently coexisting with hypertension, could also be exacerbated by some antihypertensive drugs. Male hypogonadism or subfertility are associated with increased cardiovascular risk. Hypertensive disorders in pregnancy including preeclampsia represent a major cause of maternal, fetal and neonatal morbidity, and mortality. The risk of developing preeclampsia can be substantially reduced in women at its high or moderate risk with a low dose of acetylsalicylic acid initiated from 12 weeks of gestation. An increased risk of hypertension in women following invasive-assisted reproductive technologies has been newly observed. Blood pressure elevation has been noticed following contraceptive pill use, around the menopause and in postmenopausal age. Furthermore, drug treatment of hypertension has to be considered as a factor with a potential impact on reproduction (e.g., due to teratogenic drug effects). Summary In summary, a deeper understanding of reproductive life effects on hypertension and metabolic abnormalities may improve prediction of future cardiovascular disease.

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Risk of hypertensive disorders in pregnancy following assisted reproductive technology: overview and meta‐analysis

Cited by 43 publications

References 26 publications

Immunological Tolerance, Pregnancy, and Preeclampsia: The Roles of Semen Microbes and the Father†

Immunological Tolerance, Pregnancy, and Preeclampsia: The Roles of Semen Microbes and the Father†

Association between hypertensive disorders of pregnancy and the risk of postpartum hypertension: a cohort study in women with gestational diabetes

Hypertension and Reproduction

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