Increased incidence of gestational hypertension and preeclampsia after assisted reproductive technology treatment

Capsule:
After assisted reproductive technology (ART), mothers had a 17% increased likelihood of gestational hypertension and preeclampsia compared with non-ART mothers, which was likely associated with the ART mothers’ multiple pregnancies.

Authors:
Yueping A. Wang, Ph.D., Abrar A. Chughtai, Ph.D., Cynthia M. Farquhar, M.D., Wendy Pollock, Ph.D., Kei Lui, M.D., Elizabeth A. Sullivan, M.D.

Volume 105, Issue 4, Pages 920-927

Abstract:

Objective:
To determine the association between assisted reproductive technology (ART) treatment and the rate of combined gestational hypertension (GH), preeclampsia (PE).

Design:
Retrospective population study.

Setting:
Not applicable.

Patient(s):
596,520 mothers (3.6% ART mothers) who gave birth between 2007 and 2011.

Intervention(s):
Not applicable.

Main Outcome Measure(s):
Comparison of the rate of GH/PE for ART and non-ART mothers, with odds ratio (OR), adjusted odds ratio (AOR), and 95% confidence interval (CI) used to assess the association between ART and GH/PE.

Result(s):
The overall rate of GH/PE was 4.3%, with 6.4% for ART mothers and 4.3% for non-ART mothers. The rate of GH/PE was higher for mothers of twins than singletons (12.4% vs. 5.7% for ART mothers; 8.6% vs. 4.2% for non-ART mothers). The ART mothers had a 17% increased odds of GH/PE compared with the non-ART mothers (AOR 1.17; 95% CI, 1.10–1.24). After stratification by plurality, the difference in GH/PE rates between ART and non-ART mothers was not statistically significant, with AOR 1.05 (95% CI, 0.98–1.12) for mothers of singletons and AOR 1.10 (95% CI, 0.94–1.30) for mothers of twins.

Conclusion(s):
The changes in AOR after stratification indicated that multiple pregnancies after ART are the single most likely explanation for the increased rate of GH/PE among ART mothers. The lower rate of GH/PE among mothers of singletons compared with mothers of twins suggests that a policy to minimize multiple pregnancies after ART may reduce the excess risk of GH/PE due to ART treatment.

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