Effect of chronic hypertension on assisted pregnancy outcomes: a population-based study in Ontario, Canada
Objective To evaluate maternal and neonatal outcomes in women with chronic hypertension who conceive using assisted reproductive technologies (ART). Design Population-based retrospective cohort study. Setting Obstetric hospitals in Ontario, Canada. Patient(s) Singleton pregnancies of at least 20 wee...
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| Veröffentlicht in: | Fertility and sterility 2016-04, Vol.105 (4), p.1003-1009 |
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| container_title | Fertility and sterility |
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| creator | Dayan, Natalie, M.D Lanes, Andrea, M.Sc Walker, Mark C., M.D Spitzer, Karen A., M.Sc Laskin, Carl A., M.D |
| description | Objective To evaluate maternal and neonatal outcomes in women with chronic hypertension who conceive using assisted reproductive technologies (ART). Design Population-based retrospective cohort study. Setting Obstetric hospitals in Ontario, Canada. Patient(s) Singleton pregnancies of at least 20 weeks' gestational age to women 18 years and older who delivered a live or stillborn infant between April 1, 2006, and March 31, 2012, categorized as exposed based on a diagnosis of chronic hypertension in the mother predating the index pregnancy. Intervention(s) Medically assisted pregnancy including in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI), intrauterine insemination, and ovulation induction. Main Outcome Measure(s) Primary outcome: placental-mediated complications of pregnancy (preeclampsia/eclampsia, stillbirth, fetal growth restriction/low birthweight [ |
| doi_str_mv | 10.1016/j.fertnstert.2015.11.039 |
| format | Article |
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Design Population-based retrospective cohort study. Setting Obstetric hospitals in Ontario, Canada. Patient(s) Singleton pregnancies of at least 20 weeks' gestational age to women 18 years and older who delivered a live or stillborn infant between April 1, 2006, and March 31, 2012, categorized as exposed based on a diagnosis of chronic hypertension in the mother predating the index pregnancy. Intervention(s) Medically assisted pregnancy including in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI), intrauterine insemination, and ovulation induction. Main Outcome Measure(s) Primary outcome: placental-mediated complications of pregnancy (preeclampsia/eclampsia, stillbirth, fetal growth restriction/low birthweight [<10th percentile], or clinically significant placental abruption); secondary outcomes: cesarean delivery (planned/unplanned), prematurity (<37 or <32 weeks), and neonatal death. Result(s) Our cohort included 807,765 singleton pregnancies. We used log binomial regression to compute the adjusted relative risks of the various outcomes in women with hypertension as compared with healthy women in ART and unassisted pregnancies. When we tested an interaction term between hypertension and ART in multivariate models, women with ART pregnancies were at higher risk of placental-mediated complications than were those with unassisted pregnancies (adjusted risk ratio 1.48; 95% confidence interval, 1.35, 1.56). The risk was even greater in hypertensive women (adjusted risk ratio 6.77; 95% confidence interval, 4.72, 9.72). Our findings persisted when assessing IVF only and when evaluating nulliparas. Conclusion(s) Hypertension is more frequent in ART-treated women. Hypertension increases the risk of placental complications, which appear to be compounded in ART versus unassisted pregnancies.</description><identifier>ISSN: 0015-0282</identifier><identifier>EISSN: 1556-5653</identifier><identifier>DOI: 10.1016/j.fertnstert.2015.11.039</identifier><identifier>PMID: 26690007</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Cohort Studies ; Female ; Humans ; hypertension ; Hypertension - diagnosis ; Hypertension - epidemiology ; Infant, Newborn ; Internal Medicine ; Obstetrics and Gynecology ; Ontario - epidemiology ; placental complications of pregnancy ; Population Surveillance - methods ; Pregnancy ; Pregnancy Complications - diagnosis ; Pregnancy Complications - epidemiology ; Pregnancy Outcome - epidemiology ; Reproductive Techniques, Assisted - adverse effects ; Reproductive Techniques, Assisted - trends ; Retrospective Studies ; Risk Factors</subject><ispartof>Fertility and sterility, 2016-04, Vol.105 (4), p.1003-1009</ispartof><rights>American Society for Reproductive Medicine</rights><rights>2016 American Society for Reproductive Medicine</rights><rights>Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c479t-e2b6cd978af5086467975bb2420a921cacd67718effebbf9195b9bcb508940113</citedby><cites>FETCH-LOGICAL-c479t-e2b6cd978af5086467975bb2420a921cacd67718effebbf9195b9bcb508940113</cites><orcidid>0000-0002-9036-6326</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.fertnstert.2015.11.039$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26690007$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dayan, Natalie, M.D</creatorcontrib><creatorcontrib>Lanes, Andrea, M.Sc</creatorcontrib><creatorcontrib>Walker, Mark C., M.D</creatorcontrib><creatorcontrib>Spitzer, Karen A., M.Sc</creatorcontrib><creatorcontrib>Laskin, Carl A., M.D</creatorcontrib><title>Effect of chronic hypertension on assisted pregnancy outcomes: a population-based study in Ontario, Canada</title><title>Fertility and sterility</title><addtitle>Fertil Steril</addtitle><description>Objective To evaluate maternal and neonatal outcomes in women with chronic hypertension who conceive using assisted reproductive technologies (ART). Design Population-based retrospective cohort study. Setting Obstetric hospitals in Ontario, Canada. Patient(s) Singleton pregnancies of at least 20 weeks' gestational age to women 18 years and older who delivered a live or stillborn infant between April 1, 2006, and March 31, 2012, categorized as exposed based on a diagnosis of chronic hypertension in the mother predating the index pregnancy. Intervention(s) Medically assisted pregnancy including in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI), intrauterine insemination, and ovulation induction. Main Outcome Measure(s) Primary outcome: placental-mediated complications of pregnancy (preeclampsia/eclampsia, stillbirth, fetal growth restriction/low birthweight [<10th percentile], or clinically significant placental abruption); secondary outcomes: cesarean delivery (planned/unplanned), prematurity (<37 or <32 weeks), and neonatal death. Result(s) Our cohort included 807,765 singleton pregnancies. We used log binomial regression to compute the adjusted relative risks of the various outcomes in women with hypertension as compared with healthy women in ART and unassisted pregnancies. When we tested an interaction term between hypertension and ART in multivariate models, women with ART pregnancies were at higher risk of placental-mediated complications than were those with unassisted pregnancies (adjusted risk ratio 1.48; 95% confidence interval, 1.35, 1.56). The risk was even greater in hypertensive women (adjusted risk ratio 6.77; 95% confidence interval, 4.72, 9.72). Our findings persisted when assessing IVF only and when evaluating nulliparas. Conclusion(s) Hypertension is more frequent in ART-treated women. Hypertension increases the risk of placental complications, which appear to be compounded in ART versus unassisted pregnancies.</description><subject>Adult</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Humans</subject><subject>hypertension</subject><subject>Hypertension - diagnosis</subject><subject>Hypertension - epidemiology</subject><subject>Infant, Newborn</subject><subject>Internal Medicine</subject><subject>Obstetrics and Gynecology</subject><subject>Ontario - epidemiology</subject><subject>placental complications of pregnancy</subject><subject>Population Surveillance - methods</subject><subject>Pregnancy</subject><subject>Pregnancy Complications - diagnosis</subject><subject>Pregnancy Complications - epidemiology</subject><subject>Pregnancy Outcome - epidemiology</subject><subject>Reproductive Techniques, Assisted - adverse effects</subject><subject>Reproductive Techniques, Assisted - trends</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><issn>0015-0282</issn><issn>1556-5653</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkUGP1SAQgInRuG9X_4Lh6MFWhvcKxYOJvqyrySZ7UM8E6NSl9kGF1qT_Xpq3auLJhAwhfMww3xBCgdXAQLwe6h7THPJcYs0ZNDVAzfbqEdlB04iqEc3-MdmxclMx3vILcpnzwBgTIPlTcsGFUOUkd2S47nt0M409dfcpBu_o_TqVtBiyj4GWZXL2pVJHp4TfgglupXGZXTxhfkMNneK0jGYucGVNLliel26lPtC7MJvk4yt6NMF05hl50psx4_OH_Yp8_XD95fixur27-XR8d1u5g1RzhdwK1ynZmr5hrTgIqWRjLT9wZhQHZ1wnpIQWy8et7RWoxirrbIHVgQHsr8jLc94pxR8L5lmffHY4jiZgXLIGKVvJVAO8oO0ZdSnmnLDXU_Ink1YNTG-m9aD_mtabaQ2gi-ny9MVDlcWesPvz8LfaArw_A1h6_ekx6ew8BoedT8W47qL_nypv_0niRl-GZMbvuGIe4pJCcalBZ66Z_rxNfBv4Fkt_7f4XcsurJg</recordid><startdate>20160401</startdate><enddate>20160401</enddate><creator>Dayan, Natalie, M.D</creator><creator>Lanes, Andrea, M.Sc</creator><creator>Walker, Mark C., M.D</creator><creator>Spitzer, Karen A., M.Sc</creator><creator>Laskin, Carl A., M.D</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9036-6326</orcidid></search><sort><creationdate>20160401</creationdate><title>Effect of chronic hypertension on assisted pregnancy outcomes: a population-based study in Ontario, Canada</title><author>Dayan, Natalie, M.D ; Lanes, Andrea, M.Sc ; Walker, Mark C., M.D ; Spitzer, Karen A., M.Sc ; Laskin, Carl A., M.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c479t-e2b6cd978af5086467975bb2420a921cacd67718effebbf9195b9bcb508940113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Humans</topic><topic>hypertension</topic><topic>Hypertension - diagnosis</topic><topic>Hypertension - epidemiology</topic><topic>Infant, Newborn</topic><topic>Internal Medicine</topic><topic>Obstetrics and Gynecology</topic><topic>Ontario - epidemiology</topic><topic>placental complications of pregnancy</topic><topic>Population Surveillance - methods</topic><topic>Pregnancy</topic><topic>Pregnancy Complications - diagnosis</topic><topic>Pregnancy Complications - epidemiology</topic><topic>Pregnancy Outcome - epidemiology</topic><topic>Reproductive Techniques, Assisted - adverse effects</topic><topic>Reproductive Techniques, Assisted - trends</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dayan, Natalie, M.D</creatorcontrib><creatorcontrib>Lanes, Andrea, M.Sc</creatorcontrib><creatorcontrib>Walker, Mark C., M.D</creatorcontrib><creatorcontrib>Spitzer, Karen A., M.Sc</creatorcontrib><creatorcontrib>Laskin, Carl A., M.D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Fertility and sterility</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dayan, Natalie, M.D</au><au>Lanes, Andrea, M.Sc</au><au>Walker, Mark C., M.D</au><au>Spitzer, Karen A., M.Sc</au><au>Laskin, Carl A., M.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of chronic hypertension on assisted pregnancy outcomes: a population-based study in Ontario, Canada</atitle><jtitle>Fertility and sterility</jtitle><addtitle>Fertil Steril</addtitle><date>2016-04-01</date><risdate>2016</risdate><volume>105</volume><issue>4</issue><spage>1003</spage><epage>1009</epage><pages>1003-1009</pages><issn>0015-0282</issn><eissn>1556-5653</eissn><abstract>Objective To evaluate maternal and neonatal outcomes in women with chronic hypertension who conceive using assisted reproductive technologies (ART). Design Population-based retrospective cohort study. Setting Obstetric hospitals in Ontario, Canada. Patient(s) Singleton pregnancies of at least 20 weeks' gestational age to women 18 years and older who delivered a live or stillborn infant between April 1, 2006, and March 31, 2012, categorized as exposed based on a diagnosis of chronic hypertension in the mother predating the index pregnancy. Intervention(s) Medically assisted pregnancy including in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI), intrauterine insemination, and ovulation induction. Main Outcome Measure(s) Primary outcome: placental-mediated complications of pregnancy (preeclampsia/eclampsia, stillbirth, fetal growth restriction/low birthweight [<10th percentile], or clinically significant placental abruption); secondary outcomes: cesarean delivery (planned/unplanned), prematurity (<37 or <32 weeks), and neonatal death. Result(s) Our cohort included 807,765 singleton pregnancies. We used log binomial regression to compute the adjusted relative risks of the various outcomes in women with hypertension as compared with healthy women in ART and unassisted pregnancies. When we tested an interaction term between hypertension and ART in multivariate models, women with ART pregnancies were at higher risk of placental-mediated complications than were those with unassisted pregnancies (adjusted risk ratio 1.48; 95% confidence interval, 1.35, 1.56). The risk was even greater in hypertensive women (adjusted risk ratio 6.77; 95% confidence interval, 4.72, 9.72). Our findings persisted when assessing IVF only and when evaluating nulliparas. Conclusion(s) Hypertension is more frequent in ART-treated women. Hypertension increases the risk of placental complications, which appear to be compounded in ART versus unassisted pregnancies.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26690007</pmid><doi>10.1016/j.fertnstert.2015.11.039</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-9036-6326</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Fertility and sterility, 2016-04, Vol.105 (4), p.1003-1009 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Access via ScienceDirect (Elsevier); Alma/SFX Local Collection |
| subjects | Adult Cohort Studies Female Humans hypertension Hypertension - diagnosis Hypertension - epidemiology Infant, Newborn Internal Medicine Obstetrics and Gynecology Ontario - epidemiology placental complications of pregnancy Population Surveillance - methods Pregnancy Pregnancy Complications - diagnosis Pregnancy Complications - epidemiology Pregnancy Outcome - epidemiology Reproductive Techniques, Assisted - adverse effects Reproductive Techniques, Assisted - trends Retrospective Studies Risk Factors |
| title | Effect of chronic hypertension on assisted pregnancy outcomes: a population-based study in Ontario, Canada |
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