Keele Research Repository

Background
Assisted reproductive technology (ART) has emerged as a common treatment option for infertility, a problem that affects an estimated 48 million couples worldwide. Advancing maternal age with increasing pre-pregnancy cardiovascular risk factors, such as chronic hypertension, obesity and diabetes, has raised concerns about pregnancy complications associated with ART. However, in-hospital complications following pregnancies conceived by ART are poorly described.

Methods and Results
To assess the patient characteristics, obstetric outcomes, vascular complications and temporal trends of pregnancies conceived by ART, we analysed hospital deliveries conceived with or without ART between January 1, 2008 and December 31, 2016 from the United States National Inpatient Sample database. We included 106,248 deliveries conceived with ART and 34,167,246 deliveries conceived without ART. Women who conceived with ART were older (35 vs. 28 years, p<0.0001) and had more comorbidities. ART-conceived pregnancies were independently associated with vascular complications (acute kidney injury aOR 2.52, 95% CI 1.99, 3.19, arrhythmia aOR 1.65, 95% CI 1.46, 1.86), and adverse obstetric outcomes (placental abruption aOR 1.57, 95% CI 1.41, 1.74, Cesarean delivery aOR 1.38, 95% CI 1.33, 1.43 and preterm birth aOR 1.26, 95% CI 1.20, 1.32), including in subgroups without CVD risk factors or without multifetal pregnancies. Higher hospital charges ($18,705 vs. $11,983, p<0.0001) were incurred compared to women who conceived without ART.

Conclusions
Pregnancies conceived by ART have higher risks of adverse obstetric outcomes and vascular complications compared with spontaneous conception. Clinicians should have detailed discussions on the associated complications of ART in women during pre-pregnancy counselling.