Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, Hunan, China.
Hum Reprod. 2022 Oct 31;37(11):2578-2588. doi: 10.1093/humrep/deac201.
Do differences in blood pressure within the normal range have any impacts on the live birth rate (primary outcome) or biochemical pregnancy rate (beta-hCG positivity), clinical pregnancy rate (heart beating in ultrasound), abortion rate and ectopic pregnancy rate (secondary outcomes) of fresh embryo transfer in women undergoing their IVF/ICSI treatment?
Even rather small differences in baseline blood pressure in women with normal blood pressure according to current guidelines undergoing fresh embryo transfer after IVF/ICSI affects substantially the live birth rate.
Pre-pregnancy hypertension is a well-known risk factor for adverse pregnancy events such as preeclampsia, fetal growth restriction, placental abruption and adverse neonatal events. It is likewise well known that hypertension during pregnancy in women undergoing ART is associated with adverse pregnancy outcomes. However, whether blood pressure at the high end of the normal range has an impact on ART is unknown.
STUDY DESIGN, SIZE, DURATION: It is a prospective observational cohort study based on a single IVF center between January 2017 and December 2018.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Two thousand four hundred and eighteen women with normal blood pressure undergoing fresh embryo transfer after IVF/ICSI at the Reproductive and Genetic Hospital of CITIC-Xiangya were enrolled in this study.
Blood pressure was measured at the first visit when women consulted the IVF center due to infertility. In women with a successful pregnancy outcome (1487 live births out of 2418 women undergoing fresh embryo transfer after IVF/ICSI), systolic blood pressure (SBP) (114.1 ± 9.48 mmHg versus 115.4 ± 9.8 mmHg, P = 0.001) and diastolic blood pressure (DBP) (74.5 ± 7.5 mmHg versus 75.3 ± 7.34 mmHg, P = 0.006) were lower than in those who did not achieve live births. Multivariate logistic regression analysis revealed that SBP (OR: 0.987, 95% CI: 0.979-0.996, P = 0.004) and DBP (OR: 0.986, 95% CI: 0.975-0.998, P = 0.016) were negatively associated with live birth. Similarly, SBP was significantly negatively related to clinical pregnancy rate (OR: 0.990, 95% CI: 0.981-0.999, P = 0.033), while for DBP the association was not statistically significant (OR: 0.994, 95% CI: 0.982-1.006, P = 0.343). However, both SBP and DBP were positively associated with miscarriage OR: 1.021 (95% CI: 1.004-1.037, P = 0.013) and OR: 1.027 (95% CI: 1.005-1.049, P = 0.014), respectively. Both SBP and DBP were unrelated to biochemical pregnancy (hCG positivity), implantation and ectopic pregnancy rate.
LIMITATIONS, REASONS FOR CAUTION: Whether lowering blood pressure before initiating ART treatment in women with SBP or DBP higher than the thresholds defined in our study will confer a benefit is unknown. Also, we cannot exclude bias due to different ethnicities. Moreover, participants in our study only received fresh embryo transfer, whether the results could apply to frozen embryo transfer is unclear.
Our study challenges the current blood pressure goals in women undergoing fresh embryo transfer after IVF/ICSI. Further studies are needed to figure out the mechanism and effective approach to increase IVF/ICSI pregnancy outcomes.
STUDY FUNDING/COMPETING INTEREST(S): Hunan Provincial Grant for Innovative Province Construction (2019SK4012). The authors declare that there were no conflicts of interest in this study.
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在接受体外受精/卵胞浆内单精子注射（IVF/ICSI）治疗的女性中，正常范围内血压的差异是否会对活产率（主要结局）或生化妊娠率（β-hCG 阳性）、临床妊娠率（超声心动）、流产率和异位妊娠率（次要结局）产生影响？
即使在根据当前指南接受 IVF/ICSI 后进行新鲜胚胎移植的正常血压女性中，血压的基线差异很小，也会极大地影响活产率。
孕前高血压是子痫前期、胎儿生长受限、胎盘早剥和不良新生儿事件等不良妊娠事件的已知危险因素。同样众所周知的是，接受 ART 的女性在怀孕期间的高血压与不良妊娠结局有关。然而，血压处于正常范围的较高端是否会影响 ART 尚不清楚。
研究设计、大小和持续时间：这是一项基于单个 IVF 中心的前瞻性观察队列研究，时间为 2017 年 1 月至 2018 年 12 月。
参与者/材料、设置、方法：2418 名在中信湘雅生殖遗传医院因不孕而咨询 IVF 中心的正常血压女性被纳入本研究。
女性在因不孕咨询 IVF 中心时测量血压。在成功妊娠结局（1487 例新鲜胚胎移植后活产）的女性中，收缩压（SBP）（114.1±9.48mmHg 与 115.4±9.8mmHg，P=0.001）和舒张压（DBP）（74.5±7.5mmHg 与 75.3±7.34mmHg，P=0.006）均低于未活产的女性。多变量逻辑回归分析显示，SBP（OR：0.987，95%CI：0.979-0.996，P=0.004）和 DBP（OR：0.986，95%CI：0.975-0.998，P=0.016）与活产呈负相关。同样，SBP 与临床妊娠率显著负相关（OR：0.990，95%CI：0.981-0.999，P=0.033），而 DBP 的相关性无统计学意义（OR：0.994，95%CI：0.982-1.006，P=0.343）。然而，SBP 和 DBP 均与流产呈正相关（OR：1.021，95%CI：1.004-1.037，P=0.013）和（OR：1.027，95%CI：1.005-1.049，P=0.014）。SBP 和 DBP 均与生化妊娠（β-hCG 阳性）、着床和异位妊娠率无关。
局限性、谨慎的原因：在 SBP 或 DBP 高于我们研究中定义的阈值的女性中，在开始 ART 治疗前降低血压是否会带来益处尚不清楚。此外，我们不能排除因不同种族而产生的偏见。此外，我们研究中的参与者仅接受了新鲜胚胎移植，因此不清楚这些结果是否适用于冷冻胚胎移植。
我们的研究对接受 IVF/ICSI 后进行新鲜胚胎移植的女性的当前血压目标提出了挑战。需要进一步的研究来确定增加 IVF/ICSI 妊娠结局的机制和有效方法。
研究资金/利益冲突：湖南省创新型省份建设专项资金（2019SK4012）。作者声明在这项研究中没有利益冲突。
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