Assisted reproductive technology linked to stroke during delivery hospitalization
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Key takeaways:
- Assisted reproductive technology was linked to increased likelihood of stroke during delivery hospitalization.
- The association remained significant regardless of maternal age.
Use of assisted reproductive technology was associated with increased odds of stroke during index hospitalization for delivery, regardless of maternal age, researchers reported.
The results were presented at the International Stroke Conference and simultaneously published in Stroke.
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“Infertility treatment with assisted reproductive technologies (ART) has been associated with adverse vascular events in some, but not all previous studies,” Alis J. Dicpinigaitis, MD, resident in neurology at NewYork-Presbyterian/Weill Cornell Medical Center, and colleagues wrote in the simultaneous publication. “Endothelial damage, prothrombotic factor release and a higher prevalence of cardiovascular risk factors in those receiving ART have been invoked to explain this association. We sought to explore the relationship between ART and stroke risk using population-level data.”
For this retrospective study, Dicpinigaitis, Ava L. Liberman, MD, assistant professor of clinical neurology and attending neurologist at NewYork-Presbyterian/Weill Cornell Medical Center, and colleagues assessed more than 19 million delivery hospitalizations from the National Inpatient Sample from 2015 to 2020.
The primary endpoint was any stroke, defined as ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage or cerebral venous thrombosis during index delivery hospitalization.
Of the overall cohort, 1.1% had infertility treatment with ART.
After inverse probability weighting and multivariable logistic regression analysis, the researchers observed that ART use was associated with increased likelihood of the primary endpoint (adjusted OR = 2.14; 95% CI, 2.02-2.26; P < .001).
Specifically, ART use was associated with greater likelihood of ischemic stroke (aOR = 2.75; 95% CI, 2.51-3.02; P < .001), subarachnoid hemorrhage (aOR = 3.83; 95% CI, 3.38-4.33; P < .001) and intracerebral hemorrhage (aOR = 5.37; 95% CI, 4.82-5.98; P < .001) during delivery hospitalization compared with nonuse. However, ART use was associated with decreased odds of cerebral venous thrombosis (aOR = 0.82; 95%, CI 0.72-0.93; P = .002).
Among delivery hospitalizations that resulted in occurrence of any stroke, patients who used ART had greater rates of in-hospital mortality (27.3% vs. 6.1%; P < .001) and longer hospital stays (median days, 21 vs. 5; P < .001) compared with nonusers.
Moreover, use of ART was associated with elevated risk for any stroke among patients younger than 35 years (P < .001), as well as among those aged 35 years or older (P = .004), according to the study.
“Based on our results, expanding prior recommendations that older patients should have a thorough risk assessment prior to receiving ART to include all patients planning to undergo ART may be reasonable so that treatments proven to reduce stroke risk can be initiated,” the researchers wrote. “Additionally, assuring adequate control of known stroke triggers (eg, reducing risk of infection, minimizing psychological distress) during index hospitalization for delivery may be particularly important for pregnant patients who received ART.”
Reference:
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Dicpinigaitis AJ, et al. Abstract 11. Presented at: International Stroke Conference; Feb. 7-9, 2024; Phoenix.
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