As more people wait to have children until they're older, many turn to assisted reproductive technology — such as intrauterine insemination (IUI) or in vitro fertilization (IVF) — to become parents. A new paper published in the Journal of the American Heart Association finds an increased risk of delivery and vascular complications in people who used assisted reproductive technology (ART).
“We showed that pregnancies conceived with assisted reproductive technology are independently associated with 1.7‐ and 2.5‐fold increased risks for arrhythmia and acute kidney injury, respectively, even after adjusting for baseline risk profile, such as age, obesity, diabetes, and smoking,” Dr. Pensée Wu, senior lecturer, honorary consultant obstetrician and subspecialist in maternal fetal medicine Keele University School of Medicine in the United Kingdom, told TODAY via email.
While this might sound frightening, it could mean patients might need more counseling before pregnancy; they might need to undergo some health interventions, such as controlling high blood pressure; and that their doctor might want to keep a closer eye on them and the baby.
“Women with cardiac risk factors, such as obesity or heart disease, may benefit from cardiac assessments and screening before undergoing ART,” Wu said. “Clinicians should counsel people undergoing ART that ART carries a higher risk of pregnancy complications, which will require close monitoring, particularly during delivery.”
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For the study, Wu and her colleagues examined data from more than 106,000 births conceived thanks to the help of assisted reproductive technology and more than 34 million births conceived without any assistance from 2008 to 2016.
“One of the strengths (of the study) is that it’s talking about millions of deliveries in the United States,” Dr. Jenna Turocy, at Columbia University Fertility Center, who was not involved in the study, told TODAY. “It’s retrospective, meaning it’s looking at past data, not going forward. So there are some limitations when we do a study that looks at past diagnosis.”
The findings reinforce what doctors already understood about assisted reproductive technology and increased risk cardiac and kidney problems during birth.
“Arrhythmias are well known to be one of the most common complications from a cardiac standpoint of pregnancy in general. Acute renal injury didn’t surprise me because the risk of hemorrhage at the time of delivery can quickly affect your kidneys,” Dr. Sarah Pachtman, from the maternal fetal medicine division at Northwell Health, told TODAY. “We know that there was in an increases risk because of maternal age.”
The study tried understanding whether age or using assisted reproductive technology leads to increased complicated outcomes.
“With controlling for age, they did see some increased risks with women who underwent fertility treatments,” Turocy said. “But the risks were much more significant when you look at specific age.”
Doctors have long known that advanced parental age plays a role a parent’s health during pregnancy and their chance of delivery difficulties.
“We know older women are more likely to have higher risks during pregnancies. We see a lot of patients in the infertility world that have preexisting conditions, like high blood pressure, heart defects,” Turocy said. “These things are going to increase the risks for complications during pregnancy. So these things we already knew. But it’s good to have a larger study that reinforces this knowledge.”
The experts agree that study serves as a good reminder to physicians and patients to consider a patient’s overall health and possible consequences of assisted reproductive technology.
“It’s an interesting perspective for patients who are going for infertility treatments and risks that should already be talked about and especially for older patients,” Pachtman said. “They should be speaking to their doctors about optimizing their health prenatally before pregnancy and then not forgetting that once you are pregnant that doesn’t mean you can derail your health.”
“It’s just a really good idea to be speaking with your doctor directly about what are your risks for both fertility treatments and then getting pregnant,” she said. “(Then talking) about is there anything we can do to reduce those risks before we start fertility treatment?”
While this study helps doctors better understand assisted reproductive technology and risks to heart health and during delivery, they hope future studies examine it further.
“Although our study shows that there is an association between ART and obstetric and vascular complications, we do not fully understand the mechanism,” Wu said. “This is an important area for future research.”
Turocy agreed and added that future studies might want to examine what long-term effects of these acute pregnancy and delivery episodes mean for patients.
“Still it doesn’t tell us why this is happening,” she said. “There could be some studies that looked to see, ‘Does this increase your risk for later on in life and not just during the pregnancy and delivery portion?’”