Assisted reproductive technology associated with stroke during hospitalization

Assisted reproductive technology associated with stroke during hospitalization

February 12, 2024

2 min reading


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Key relationships:

  • Assisted reproductive technology was associated with increased odds of stroke during hospitalization for childbirth.
  • The association remained significant regardless of maternal age.

The use of assisted reproductive technology was associated with increased odds of stroke during hospitalization for delivery, regardless of maternal age, the researchers reported.

The results were presented at the International Stroke Conference and published simultaneously in Stroke.

pregnant
Assisted reproductive technology was associated with increased odds of stroke during hospitalization for childbirth.
Image: Adobe Stock

“Infertility treatment with assisted reproductive technology (ART) has been associated with adverse vascular events in some but not all previous studies.” Alice J. Dicpinigaitis, MD, resident in neurology at NewYork-Presbyterian/Weill Cornell Medical Center and colleagues wrote in the concurrent publication. “Endothelial damage, release of prothrombotic factor, and a higher prevalence of cardiovascular risk factors in those taking 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 evaluated more than 19 million 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 hospitalization during the index delivery.

Of the total group, 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 odds of the primary endpoint (adjusted OR = 2.14; 95% CI, 2.02–2.26; P < .001).

Specifically, ART use was associated with greater odds 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 hospitalization compared with no use. However, ART use was associated with reduced odds of cerebral venous thrombosis (aOR = 0.82; 95% CI 0.72–0.93; P = .002).

Among labor admissions resulting in a stroke, patients using ART had higher in-hospital mortality rates (27.3% vs. 6.1%; P < .001) and longer hospital stays (median days, 21 vs. 5; P < .001) compared to nonusers.

Furthermore, ART use was associated with increased risk for any stroke among patients younger than 35 years (P < .001), as well as among those aged 35 and over (P = .004), according to the study.

“Based on our results, expanding previous recommendations that elderly patients should have a thorough risk assessment before receiving ART to include all patients planning to undergo ART may be reasonable so that can start treatments proven to reduce stroke risk,” the researchers wrote. “Furthermore, ensuring adequate control of known stroke triggers (eg, reducing risk of infection, minimizing psychological distress) during the index hospitalization for delivery may be particularly important for patients pregnant women who have received ART.”

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