Infertility Treatments Could Raise Risk of Acute Kidney Injury, Heart Rhythm Disorders

Penseé Wu, MBChB, MD

Common treatments for infertility could be accompanied by an increased risk of in-hospital complications and other adverse pregnancy outcomes, according to the results of a new study.

An analysis comparing deliveries of children conceived with and without assisted reproductive therapy (ART), results of the analysis suggest conception with ART was independently associated with 1.7- and 2.5-fold increased risks for arrhythmia and acute kidney injury, respectively, after adjustment for baseline risk profile.

“We were surprised that assisted reproductive technology was independently associated with these complications, as opposed to being associated with only the existence of pre-existing health conditions or only among older women undergoing infertility treatment,” said lead investigator Pensée Wu, MBChB, MD, senior lecturer and honorary consultant obstetrician and subspecialist in Maternal Fetal Medicine at Keele University School of Medicine in Staffordshire, United Kingdom, in a statement.

Published on February 22, the study is part of a special Go Red for Women issue of the Journal of the American Heart Association. Citing knowledge gaps related to risk of in-hospital complications following pregnancies conceived by ART, Wu and a team of colleagues designed the study as a retrospective analysis of pregnancies within the US National Inpatient Sample database. Including all women admitted for delivery from 2008-2016, investigators identified an unweighted cohort of 7,236,075 deliveries, which was weighted to represent 106,248 deliveries conceived by ART and 34,167,246 deliveries conceived without ART.

For the purpose of analysis, investigators used binary logistic regression adjusted for age, median ZIP code income quartile, primary payer, race and ethnicity, weekday admission, year of admission, and comorbidities associated with cardiovascular disease to assess associations of ART with maternal and obstetric outcomes. Investigators noted plans for temporal analyses with pregnancies stratified by year, with groups defined as 2008-2010, 2011-2013, and 2014-2016.

Over the study period, the percentage of delivery episodes from ART increased from 0.05% in 2008 to 0.51% in 2016 (P <.001). Compared to those who did not conceive with ART, women who conceived by ART were older (median age: 35 vs 28 years; P <.0001), more likely to be White women (66.13% vs 47.82%; P <.0001), and more likely to be in the wealthiest quartile of household income (54.63% vs 21.42%; P <.0001).

Results of the investigators’ analyses indicated ART-conceived pregnancies were independently associated with increased risk of acute kidney injury (aOR, 2.52 [95% CI 1.99-3.19]; P <.0001) and arrhythmia (aOR, 1.65 [95% CI, 1.46-1.86]; P <.0001). ART-conceived pregnancies were also independently associated with increased risk of adverse obstetric outcomes, including placental abruption (aOR, 1.57 [95% CI, 1.41–1.74]; P <.0001), cesarean delivery (aOR, 1.38 [95% CI, 1.33-1.43]; P <.0001) and preterm birth (aOR, 1.26 [95% CI, 1.20-1.32]; P <.0001). Investigators pointed out consistent trends were observed across subgroups without cardiovascular disease risk factors or without multifetal pregnancies. Investigators also noted the results demonstrated women who conceived with ART incurred higher hospital charges than those who conceived without ART ($18,705 vs $11,983; P <.0001).

“Especially patients with existing cardiovascular risk factors should be counseled about the potentially long-term cardiovascular implications and risks associated with ART,” Wu added. “It’s important for women to know that assisted reproductive technology carries a higher risk of pregnancy complications, which require close monitoring, particularly during delivery. Primary and specialist health care professionals should ensure these risks are communicated and strategies to mitigate them are discussed and implemented.”

This study, “In-Hospital Complications in Pregnancies Conceived by Assisted Reproductive Technology,” was published in the Journal of the American Heart Association.