“What was apparent was that any woman who develops gestational diabetes or preeclampsia did in the end have higher incidence of cardiovascular risk factors. That, of course, still should be a key caveat in the care of these women,” said Susan Bennett, MD, FACC.

According to results from the GRAVID study, the use of fertility therapy does not appear to increase the long-term risk of cardiovascular complications in women who give birth following fertility therapy. The results were published July 31 in the Journal of the American College of Cardiology.

The GRAVID (General Reproductive Assistance and Vascular Illness Downstream) study is the largest-ever population study to examine the long-term risk of cardiovascular consequences following fertility therapy, and followed nearly 1.2 million women who gave birth in Ontario, Canada, between July 1, 1993 and March 31, 2010. Results showed at 9.7 years of median follow-up, the 6,979 women in the cohort who gave birth following fertility therapy had fewer cardiovascular events than the controls (103 vs. 117 events per 100,000 person-years), equivalent to an unadjusted HR 0.96 (95 percent confidence interval [CI], 0.72-1.29, p=0.79) and an adjusted HR 0.55 (95 percent CI, 0.41-0.74, p<0.0001). The reduced risk of cardiovascular complications was seen across all age, education and socioeconomic subgroups. Further, “women who received fertility therapy also had lower risk-adjusted all-cause mortality, thromboembolic events, subsequent depression, alcoholism, and self-harm (p<0.01 for each).”

 

“The potential association between fertility therapy and subsequent cardiovascular disease is increasingly relevant given societal trends for women to delay pregnancy until older age with a higher likelihood of baseline heart disease,” note the authors. “A better understanding of the long-term risks associated with fertility therapy might help inform decision-making around reproductive technology and motivate cardiovascular risk reduction. The current findings provide some reassurance that fertility therapy does not appear to increase long-term risk of cardiovascular events following successful pregnancy,” the authors conclude.

They add that their findings are in contrast with other studies, and suggest that the difference may be due to the larger population and longer term of the current study. They also recommend that their findings be approached with caution, as “population-based cohort studies have limitations due to potentially missing clinical data yet remain powerful designs to examine adverse outcomes otherwise missed in randomized trials.”

“The findings in this study are reassuring for women who need fertility treatment,” said Jolien Roos-Hesselink, MD, PHD, Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands in a related editorial comment. “But overall, we should remember that the population needing fertility treatment is actually at increased risk of cardiovascular and metabolic disease. These data can only be applied to those people who conceived and had a live birth. The outcome in those women whose (fertility) treatment is unsuccessful may be very different and should be investigated.”

Additional Resources CardioSmart for Your Patients: In Vitro Fertilization for Infertility CardioSmart for Your Patients: Infertility Treatment Decision Aid CardioSmart for Your Patients: Infertility: Questions to Ask About Medicine or Hormone Treatment

Keywords: Follow-Up Studies, Risk Reduction Behavior, Live Birth, Pre-Eclampsia, Reproductive Techniques, Fertility, Heart Diseases, Incidence, Diabetes, Gestational, Cardiovascular Diseases, Probability, Confidence Intervals, United States, Pregnancy

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