• Wu et al. (Journal of the American Heart Association, 2022) assessed the relationship between pregnancies conceived by ART and adverse obstetric outcomes and vascular complications  

• Population-based study 
  • Data derived from the US National Inpatient Sample (NIS) database 
  • Contains hospital discharges  
• Population 
  • All women admitted for delivery 
  • Between January, 2008 and December, 2016 
• Exposures 
  • ART (all delivery records with an ART code) 
• Study design 
  • Logistic regression analyses were used to assess the association of ART with maternal and obstetric outcomes 
  • Adjustments: Age | Median ZIP code income quartile | Primary payer | Race and ethnicity | Weekday admission | Year of admission | Comorbidities associated with CVD 
  • Comorbidities associated with CVD included: Chronic kidney disease | Congenital heart disease | Congestive heart failure | Depression | Diabetes |Dyslipidemia | Hypertension | Multifetal pregnancy | Obesity | Preeclampsia/eclampsia | Previous myocardial infarction | Previous transient ischemic attack or stroke | Smoker | Valvular disease 

• Primary outcomes 
  • Vascular complications 
    • Acute kidney injury | Arrhythmia | Ischemic stroke | Peripartum cardiomyopathy | Venous thromboembolism 
  • Obstetric outcomes 
    • Cesarean delivery | Placental abruption | Preterm birth 
  • Cost outcomes 
    • Length of stay | Total billed hospitalization charge 

• 34,167,246 total deliveries 
  • Conceived with ART: 106,248  
  • Women who conceived with ART  
    • Were older: 35 vs 28 years (P<0.0001) 
    • Had more comorbidities 
• ART-conceived pregnancies were independently associated with  
  • Vascular complications  
    • Acute kidney injury: aOR 2.52 (95% CI, 1.99 to 3.19) 
    • Arrhythmia: aOR 1.65 (95% CI, 1.46 to 1.86) 
  • Adverse obstetric outcomes  
    • Placental abruption: aOR 1.57 (95% CI, 1.41 to 1.74) 
    • Cesarean delivery: aOR 1.38 (95% CI, 1.33 to 1.43) 
    • Preterm birth: aOR 1.26 (95% CI, 1.20 to 1.32) 
• These trends also occurred in subgroups without CVD risk factors or without multifetal pregnancies 
• Compared to women who conceived without ART, women who conceived with ART  
  • Had longer peridelivery length of stay (P<0.0001)  
    • Median 3 vs 2 days  
  • Incurred higher hospital changes (P<0.0001) 
    • Without ART: $11,983 
    • With ART: $18,705 

• Pregnancies conceived by ART are at higher risk for vascular complications and adverse obstetrical outcomes  
• The authors state 

Primary and specialist care clinicians should counsel women that assisted reproductive technology carries a higher risk of obstetric and vascular complications which will require close monitoring, particularly during delivery 

While our study did not explore the relationship between assisted reproductive technology and long‐term cardiovascular disease, there is growing understanding that additive adverse effects of infertility may have implications on long‐term cardiovascular risks through shared pathogenesis and vascular dysfunction 

In-Hospital Complications in Pregnancies Conceived by Assisted Reproductive Technology 

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