Abstract

Although in vitro fertilization (IVF) has been associated with an increased risk for hypertensive disorders of pregnancy, the association of risk with IVF treatment parameters is unclear.To evaluate risk for hypertensive disorders of pregnancy by maternal fertility status, and IVF treatment parameters.Women in 8 States who underwent IVF resulting in a live birth during 2004 through 2013 were linked to their infant's birth certificates. A 10:1 sample of births from non-IVF deliveries were selected for comparison. Those with an indication of infertility treatment on the birth certificate were categorized as subfertile and omitted for the study population; all others were categorized as fertile. The IVF pregnancies were additionally categorized by oocyte source (autologous vs donor) and embryo state (fresh vs thawed). Both the fertile and IVF births were limited to singletons only, and the IVF pregnancies were limited to those using partner sperm. Hypertensive disorders of pregnancy (including gestational hypertension and preeclampsia) were identified from the birth certificate, modeled using logistic regression, and reported as adjusted odds ratios (AOR) and 95% confidence intervals. For analyses of IVF pregnancies from autologous oocytes-fresh embryos, the reference group was fertile women (subgroup analysis 1). For analyses within the IVF group, the reference group was autologous oocytes- fresh embryos (subgroup analysis 2).The study population included 1,465,893 pregnancies (1,382,311 births to fertile women and 83,582 births to IVF-treated women). Compared to fertile women, IVF women with autologous-fresh cycles did not have an increased risk for hypertensive disorders of pregnancy [AOR 1.04, 95% CI 0.99, 1.08]. Among IVF births (subgroup analysis 2), the risk for hypertensive disorders of pregnancy was increased for autologous-thawed, 1.30 [1.20, 1.40]; donor-fresh, 1.92 [1.71, 2.15]; donor-thawed, 1.70 [1.47, 1.96]. Excluding women with pregestational diabetes or chronic hypertension, and adjusting for body mass index and infertility diagnoses did not substantially change the results. When stratified by <34 weeks (early onset hypertensive disorders of pregnancy) versus =34 weeks (late onset hypertensive disorders of pregnancy), only the donor-fresh group had an increased risk for early-onset, but the risks for all other oocyte source-embryo state groups compared to autologous-fresh were increased for late-onset.The risk for hypertensive disorders of pregnancy is increased for IVF-treated women and in pregnancies conceived via frozen embryo transfer (with both autologous or donor oocyte) and fresh donor oocyte embryo transfer. No increase in risk was seen with fresh autologous IVF cycles. Excluding women with pregestational diabetes or chronic hypertension, and adjusting for body mass index and infertility diagnoses did not substantially change the results.

View details for DOI 10.1016/j.ajog.2019.10.003

View details for PubMedID 31629726