Fertil Steril. 2024 May 21:S0015-0282(24)00460-6. doi: 10.1016/j.fertnstert.2024.05.150. Online ahead of print.
ABSTRACT
OBJECTIVE: To explore whether maternal baseline systolic and diastolic blood pressure (SBP and DBP) affect pregnancy outcomes particularly in normotensive women (SBP within 90-139 mmHg, DBP within 60-89 mmHg) but also hypertensive women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).
DESIGN: Retrospective cohort study.
SUBJECTS: The study included 73,462 patients who underwent IVF/ICSI at the Reproductive and Genetic Hospital of CITIC-Xiangya between January 1, 2016, and November 30, 2020, selected based on pre-established criteria. Analysis was limited to the first transfer cycle of the first stimulation cycle.
EXPOSURE: Baseline SBP and DBP.
MAIN OUTCOME MEASURES: Primary outcome focused on the live birth rate (LBR), with secondary outcomes including clinical pregnancy rate, ectopic pregnancy rate, first trimester miscarriage rate, 2nd or 3rd trimester fetal loss, and delivery/neonatal/maternal outcomes. Analytical methods included Poisson regression, linear regression, linear mixed-effect model, and restricted cubic spline analysis as appropriate.
RESULTS: For normotensive women, a 10mmHg increase in SBP was associated with an adjusted relative risk (aRR) of 0.988 (95% CI: 0.981-0.995, P=0.001) for live birth likelihood. DBP, however, was not significantly associated with LBR after adjustments. Secondary outcomes indicated that increases in SBP and DBP were associated with higher risks of first trimester miscarriage, gestational diabetes mellitus, and gestational hypertension in the normotensive subset. Sensitivity analyses confirmed these associations between SBP/DBP and LBR, consistent with the main findings even under stricter guidelines and after adjusting for multiple confounders. Subgroup analyses showed variation in the impact of blood pressure on LBR across different demographics and conditions. Consistent with earlier studies on blood pressure and birth outcomes, we found a 5.4% (aRR per 10mmHg =0.946, 95%CI: 0.907-0.986, P =0.009) reduction of LBR in the hypertensive subgroup.
CONCLUSION: SBP impacted LBR outcomes in normotensive women undergoing IVF/ICSI, might suggest the need for reconsidering blood pressure management guidelines for reproductive-aged women, focusing on reproductive health in addition to cardiovascular risk.
PMID:38782112 | DOI:10.1016/j.fertnstert.2024.05.150
