In-Hospital Complications in Pregnancies Conceived by Assisted Reproductive Technology

• Authors: Pensée Wu, Keele University; Garima Sharma, Johns Hopkins University; Laxmi S Mehta, Ohio State University; Carolyn A Chew-Graham, Keele University; Gina Lundberg, Emory University; Kara A Nerenberg, University of Calgary; Michelle M Graham, University of Alberta; Lucy C Chappell, King’s College London; Umesh T Kadam, University of Leicester; Kelvin P Jordan, Keele University; Mamas A Mamas, Keele University
• Journal Title: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: Volume 11, Number 5
• Publisher: WILEY | 2022-03-01, Pages e022658-e022658
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1161/JAHA.121.022658
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; cardiovascular disease risk factors; in vitro fertilization; pregnancy; prevention; MAJOR BIRTH-DEFECTS; SINGLETON PREGNANCIES; CARDIOVASCULAR RISK; PERINATAL OUTCOMES; UNITED-STATES; INFERTILITY; WOMEN; METAANALYSIS; PREVALENCE; IVF/ICSI

Abstract

BACKGROUND: Assisted reproductive technology (ART) has emerged as a common treatment option for infertility, a problem that affects an estimated 48 million couples worldwide. Advancing maternal age with increasing prepregnancy cardiovascular risk factors, such as chronic hypertension, obesity, and diabetes, has raised concerns about pregnancy complications associated with ART. However, in-hospital complications following pregnancies conceived by ART are poorly described. METHODS AND RESULTS: To assess the patient characteristics, obstetric outcomes, vascular complications and temporal trends of pregnancies conceived by ART, we analyzed hospital deliveries conceived with or without ART between January 1, 2008, and December 31, 2016, from the United States National Inpatient Sample database. We included 106 248 deliveries conceived with ART and 34 167 246 deliveries conceived without ART. Women who conceived with ART were older (35 versus 28 years; P<0.0001) and had more comorbidities. ART-conceived pregnancies were independently associated with vascular complications (acute kidney injury: adjusted odds ratio [aOR], 2.52; 95% CI 1.99– 3.19; and arrhythmia: aOR, 1.65; 95% CI, 1.46–1.86), and adverse obstetric outcomes (placental abruption: aOR, 1.57; 95% CI, 1.41–1.74; cesarean delivery: aOR, 1.38; 95% CI, 1.33–1.43; and preterm birth: aOR, 1.26; 95% CI, 1.20–1.32), including in subgroups without cardiovascular disease risk factors or without multifetal pregnancies. Higher hospital charges ($18 705 versus $11 983; P<0.0001) were incurred compared with women who conceived without ART. CONCLUSIONS: Pregnancies conceived by ART have higher risks of adverse obstetric outcomes and vascular complications compared with spontaneous conception. Clinicians should have detailed discussions on the associated complications of ART in women during prepregnancy counseling.