Center for Nutrition and Health Research, National Institute of Public Health, Avenida Universidad No. 655, Santa Maria Ahuacatitlan, 62100, Cuernavaca, Morelos, Mexico.
Present affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA.
BMC Pregnancy Childbirth. 2022 Jul 7;22(1):549. doi: 10.1186/s12884-022-04885-8.
Infertility has been associated with the risk of adverse pregnancy outcomes. It is not clear whether infertility and underlying causes of infertility or the use of medically assisted reproduction (MAR) therapies are responsible for the observed associations. In this study, we aimed to evaluate the association of history of infertility with pregnancy outcomes and identify whether the associations, if present, differed by subgroups defined by the use of MAR.
Prospective study of 2201 pregnant women from the Boston-area Project Viva cohort. The exposure was history of infertility based on self-reported time to pregnancy ≥12 mo (or ≥ 6 mo if ≥35 y) or use of MAR; a diagnosis of infertility or claims for infertility treatments from medical records. The outcomes included: gestational glucose tolerance (gestational diabetes, impaired glucose tolerance, isolated hyperglycemia vs. normoglycemia), hypertensive disorders (gestational hypertension/preeclampsia vs. normotension), gestational weight gain (inadequate/excessive vs. adequate), systolic (SBP) and diastolic blood pressure, birthweight-for-gestational age z-score (tertile 2 and 3 vs. 1), preterm birth (<37 vs. ≥37 weeks at delivery), and birth outcome (pregnancy loss vs. live birth). We performed linear and logistic/multinomial regression analyses adjusted for age, race/ethnicity, age at menarche, pre-pregnancy BMI, and prenatal smoking.
Mean (SD) age was 32.0 (5.0) years, and 18.8% of women had history of infertility, 32.6% of whom used MAR. SBP across pregnancy was 0.72 mmHg higher in women with vs. without infertility (95% CI 0.02, 1.42). The associations were stronger among women who used MAR (β 1.32 mmHg, 95% CI 0.21, 2.44), especially among those who used gonadotropins or gonadotropin-releasing hormone [GnRH] agonists (β 1.91 mmHg, 95% CI 0.48, 3.35). Other outcomes were not associated with history of infertility.
A history of infertility was associated with higher SBP during pregnancy, with stronger associations among those who used gonadotropins or GnRH agonists. Future studies are needed to confirm these findings and determine their clinical implications.
不孕与不良妊娠结局的风险有关。目前尚不清楚不孕及其潜在原因，或是否使用医学辅助生殖（MAR）治疗是导致这些关联的原因。在这项研究中，我们旨在评估不孕史与妊娠结局的关系，并确定如果存在关联，这些关联是否因 MAR 使用的亚组而不同。
前瞻性研究了来自波士顿地区项目 Viva 队列的 2201 名孕妇。暴露因素是根据自我报告的时间怀孕≥12 个月（或≥35 岁时≥6 个月）或使用 MAR；从病历中诊断出不孕或要求进行不孕治疗。结果包括：妊娠期葡萄糖耐量（妊娠糖尿病、糖耐量受损、单纯高血糖与正常血糖）、高血压疾病（妊娠高血压/子痫前期与正常血压）、妊娠期体重增加（不足/过多与适当）、收缩压（SBP）和舒张压、出生体重-胎龄 z 评分（三分位 2 和 3 与 1）、早产（<37 与≥37 周分娩）和出生结局（妊娠丢失与活产）。我们进行了线性和逻辑/多项回归分析，调整了年龄、种族/民族、初潮年龄、孕前 BMI 和产前吸烟。
平均（SD）年龄为 32.0（5.0）岁，18.8%的女性有不孕史，其中 32.6%的人使用了 MAR。与无不孕史的女性相比，有不孕史的女性在整个孕期的 SBP 高 0.72mmHg（95%CI 0.02，1.42）。这种关联在使用 MAR 的女性中更强（β 1.32mmHg，95%CI 0.21，2.44），尤其是使用促性腺激素或促性腺激素释放激素[GnRH]激动剂的女性（β 1.91mmHg，95%CI 0.48，3.35）。其他结局与不孕史无关。
不孕史与妊娠期 SBP 升高有关，在使用促性腺激素或 GnRH 激动剂的女性中关联更强。需要进一步的研究来证实这些发现并确定其临床意义。
