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Women who conceived via assisted reproductive technologies (ART) were more likely to develop eclampsia during pregnancy, researchers found.

ART procedures, such as in vitro fertilization, were associated with more than a 50% increased risk of eclampsia (aOR 1.53, 95% CI 1.40-1.67), reported Adriana Facchiano, a medical student at Temple University Lewis Katz School of Medicine in Philadelphia, and colleagues.

Multiple gestations -- which occurred in almost 30% of ART pregnancies -- also were associated with eclampsia, and more research is needed to analyze this potential risk, Facchiano said in a presentation at the American College for Obstetricians and Gynecologists (ACOG) virtual meeting.

"Despite increased vigilance noted in many of these pregnancies, ART is a significant risk factor for eclampsia," Facchiano stated.

She noted that a higher proportion of ART patients had multiple gestations, which is expected as infertility treatments increase the risk of multiple pregnancy when more than one embryo is implanted. As multiple gestation also was linked with eclampsia, Facchiano said that "further analysis is necessary to determine the impact of and mechanisms through which multiple gestations can increase eclampsia."

Eclampsia is a severe complication of preeclampsia, and is characterized by high blood pressure that can cause seizures during pregnancy. Recent studies have tied infertility treatments to hypertensive disorders of pregnancy, but the incidence of eclampsia in this population has not been previously described, Facchiano said. Her group conducted a retrospective case-control study using the CDC database. They obtained information about live births in the U.S. between 2016 and 2018.

Facchiano and colleagues used a logistic regression model, controlling for factors known to contribute to preeclampsia and eclampsia, such as maternal age, ethnicity, BMI, diabetes, smoking status, multiple gestations, number of prenatal visits, and type of insurance coverage.

The group reviewed nearly 11 million births, approximately 120,000 of which were conceived using assisted reproductive procedures. Eclampsia occurred in 571 women who underwent ART, and 27,785 women who did not.

Patients who used ART were older (about age 36 versus about age 29 for no-ART patients), and a greater proportion had diabetes, hypertension, or smoked before pregnancy. ART patients were more likely to attend a higher number of prenatal visits, and less likely to have Medicaid insurance.

The unadjusted odds ratio of developing eclampsia for patients who underwent ART was 1.86 (95% CI 1.71-2.02). After adjustment the odds were lower, but still significant.

The only covariates found to have a stronger relationship with eclampsia were pre-pregnancy hypertension, pre-pregnancy diabetes, and multiple births per pregnancy, according to the researchers.

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