title: Risk of Preeclampsia in Pregnancies After Assisted Reproductive Technology and Ovarian Stimulation.
abstract: Objective To compare the risk of preeclampsia among spontaneously conceived pregnancies to those after hyperestrogenic ovarian stimulation (hyperestrogenic OS) with and without assisted reproductive technology (ART), and stimulation with non-hyperestrogenic aromatase inhibitor stimulation (non-hyperestrogenic OS). Methods Live-born singleton deliveries among women 20-49 years were identified in the 2004-2012 Truven Health MarketScan Commercial Claims and Encounters Databases using ICD-9 and CPT codes. Maternal characteristics were compared using Chi squared and Fisher exact tests. We performed multilevel multivariable logistic regression, controlling for maternal age, parity, comorbid conditions, and region of delivery, and calculated adjusted odds ratios (aOR) and 95 % confidence intervals for mild and severe preeclampsia. Results 1,014,526 spontaneously conceived, 6881 hyperestrogenic OS with ART, 27,516 hyperestrogenic OS without ART, and 2117 non-hyperestrogenic OS pregnancies were identified. The adjusted odds of developing preeclampsia were increased for deliveries after hyperestrogenic OS with ART (mild preeclampsia aOR 1.42, 1.24-1.62; severe preeclampsia aOR 1.83, 1.59-2.11) and without ART (mild preeclampsia aOR 1.32, 1.24-1.42; severe preeclampsia aOR 1.53, 1.41-1.66). Adjusted odds of preeclampsia were similar between spontaneously conceived and non-hyperestrogenic OS pregnancies. Conclusions for Practice Risk of preeclampsia after ART may in part be related to supraphysiologic estrogen associated with hyperestrogenic OS.
authors.affiliation: Department of Gynecology and Obstetrics, Emory University, 69 Jesse Hill Jr. Drive, SE, 4th Floor, Glenn Building, Atlanta, GA, 30303, USA. amatlac@emory.edu.|Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA. amatlac@emory.edu.
authors.forename: Angela S
authors.initials: AS
authors.lastname: Martin
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Monsour
authors.affiliation: Department of Gynecology and Obstetrics, Emory University, 69 Jesse Hill Jr. Drive, SE, 4th Floor, Glenn Building, Atlanta, GA, 30303, USA.|Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Kawwass
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA.
authors.forename: Sheree L
authors.initials: SL
authors.lastname: Boulet
authors.affiliation: Department of Gynecology and Obstetrics, Emory University, 69 Jesse Hill Jr. Drive, SE, 4th Floor, Glenn Building, Atlanta, GA, 30303, USA.|Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA.
authors.forename: Dmitry M
authors.initials: DM
authors.lastname: Kissin
authors.affiliation: Department of Gynecology and Obstetrics, Emory University, 69 Jesse Hill Jr. Drive, SE, 4th Floor, Glenn Building, Atlanta, GA, 30303, USA.|Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D050498:Live Birth; D016015:Logistic Models; D008423:Maternal Age; D009035:Mothers; D010062:Ovulation Induction; D011225:Pre-Eclampsia; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D027724:Reproductive Techniques, Assisted; D012307:Risk Factors
keywords: Aromatase inhibitors; Assisted reproductive technology; In vitro fertilization; Ovarian stimulation; Preeclampsia