Abstract
BackgroundHypertensive disorders of pregnancy (HDP) is one of the most common pregnancy complications and causes of maternal morbidity and mortality. Many cohort studies were conducted to study adverse pregnancy outcomes associated with pregnancies from assisted reproductive technology. We aimed to comprehensively review all available evidence to date to compare the odds of HDP and preeclampsia between pregnancies achieved by in vitro fertilization (IVF) and spontaneous pregnancies.MethodsWe conducted a systematic review and meta-analysis based on cohort studies identified from EMBASE, MEDLINE, and Cochrane Library (up to 2020) and manually using a structured search strategy. Cohort studies that compared pregnancies after IVF with or without intracytoplasmic sperm fertilization (ICSI) and SC with HDP or preeclampsia as the outcome of interest were included. The control group was women who conceived spontaneously without ART or fertility medications. Studies published in English, French, Chinese, and Portuguese were reviewed. Eligibility and quality of studies were evaluated by two reviewers independently. Quality assessment was conducted using the Newcastle Ottawa Scale (NOS) for Cohort Studies. The pooled results were reported in odds ratios (OR) with 95% confidence intervals based on random effects models. I-squared (I2) test was used to evaluate heterogeneity and publication bias was assessed using funnel plots.ResultsSeventy-eight studies were included after a screening of 1,879 abstracts and 275 full text articles. Compared to SC, IVF/ICSI singleton pregnancies (OR 1.63; 95% CI 1.54-1.74; I2 = 79%) and multiple pregnancies (OR 1.31; 95% CI 1.18-1.47; I2 = 73%) were both associated with higher odds of HDP. Singleton pregnancies with oocyte donation had the highest odds of HDP out of all groups analyzed (OR 4.11; 95% CI 2.75-6.16; I2 = 85%). Frozen embryo transfer resulted in higher odds of HDP (OR 1.74; 95% CI 1.58-1.92; I2 = 55%) than fresh embryo transfer (OR 1.43; 95% CI 1.33-1.53; I2 = 72%). Similar findings for preeclampsia were also reported.ConclusionsOur meta-analysis confirmed that IVF/ICSI pregnancies are at high odds of HDP and preeclampsia than SC, irrespective of the plurality. The odds were especially high in frozen embryo transfer and oocyte donation pregnancies.
Assisted Reproductive Technology and Hypertensive Disorders of Pregnancy: Systematic Review and Meta-Analyses
