Medical Student The University Of British Columbia The University of British Columbia Vancouver, British Columbia, Canada
Background: Assisted reproductive technologies (ART) involve the manipulation of eggs, sperm, or embryos to achieve pregnancy in individuals with infertility. With increasing accessibility to ART in Canada, a larger cohort of women are able to achieve pregnancy. This includes women with underlying cardiovascular disease (CVD), who have unique physiological considerations that must be addressed during ART treatment, in addition to the significant maternal changes that occur during pregnancy. Currently, there are no studies investigating the effects of ART on women with CVD. This study aimed to assess whether ART increases the risk of adverse cardiac, obstetric, or fetal/neonatal outcomes in a cardiac patient population.
METHODS AND RESULTS: This is a retrospective cohort study of women with CVD who underwent ART referred to the St. Paul’s Hospital Cardiac Obstetrics Clinic between January 2021 and January 2024. A total of 76 pregnancies in 72 women were identified. Most patients (81.5%) were of advanced maternal age, with a mean age of 39 years. Seventy-four pregnancies (97.4%) were singleton gestations, and 29 women (39.2%) were primigravida. Underlying cardiac diagnoses included acquired heart disease in 48 pregnancies (63.2%) and congenital heart disease in 28 pregnancies (36.8%). The most common ART modality was in vitro fertilization (IVF) using autologous oocytes. No cases of ovarian hyperstimulation syndrome (OHSS) were observed prior to pregnancy. Obstetrical complications during the antepartum period were frequent: gestational hypertension occurred in 13 pregnancies (17.1%), gestational diabetes in 9 (11.8%), and intrauterine growth restriction in 8 (10.5%). Cardiac complications occurred in 13 pregnancies (17.1%), due to arrhythmia recurrence (14.5%) and new heart failure (2.6%). Notably, there were no major adverse maternal cardiovascular events during the antepartum or postpartum period, including thromboembolism, stroke, or cardiovascular death. Neonatal outcomes were generally favourable. Mean gestational age at delivery was 38 weeks and 3 days. There were no cases of fetal demise beyond 20 weeks, neonatal death, or intraventricular hemorrhage. NICU admission was required in 15 neonates (19.2%). The most common fetal complication was congenital cardiac anomalies, identified in 4 neonates (5.1%), all born to mothers with congenital heart disease.
Conclusion: Use of ART is generally safe in women with underlying CVD, with no major adverse maternal cardiac or fetal/neonatal events observed. However, obstetrical complications during the antepartum period were frequent. Future comparison with a comorbidity-matched cohort who did not undergo ART will help clarify whether ART adds risk to this cardiac population.
