Women using assisted reproductive technology may be at higher risk for stroke: Study

After accounting for stroke risk factors, those who had an assisted reproductive technologies code in their record at the time of the delivery hospitalization had significantly higher rates of any stroke, subarachnoid haemorrhage, acute ischemic stroke, and intracerebral haemorrhage compared with those without any prior ART use, Alis J. Dicpinigaitis, New York Presbyterian-Weill Cornell Medical Center, US, reported at the International Stroke Conference.

Some, but not all, previous studies have shown that infertility treatment with assisted reproductive technologies has been linked with adverse vascular events. This association may be explained by endothelial damage, prothrombotic factor release, and a higher prevalence of cardiovascular (CV) risk factors in those receiving ART.

Because the handful of studies that have examined links between ART and cerebrovascular disease have provided mixed results, Dr. Dicpinigaitis and his team aimed to explore the relationship between ART and stroke risk using population-level data.

For this purpose, they conducted a retrospective cohort study using data from the NIS (National Inpatient Sample) registry from 2015-2020, including all delivery hospitalizations for women aged 15-55 years.

The study exposure was the use of ART. The primary endpoint was any stroke defined as cerebral venous thrombosis (CVT), intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH), or ischemic stroke (IS) during index delivery hospitalization. Secondary endpoints were individual stroke subtypes (CVT, ICH, IS and ICH).

Study exposure, comorbidities, and prespecified endpoints were defined using Standard International Classification of Diseases, Tenth Revision, and Clinical Modification (ICD-10-CM) algorithms. In addition to reporting population-level estimates, propensity score (PS) adjustment by inverse probability weighting (IPW) was used to mimic the randomization effects by balancing baseline clinical characteristics associated with stroke between ART and non-ART users.

The study led to the following findings:

• Among 19,123,125 delivery hospitalizations identified, patients with prior ART (n = 202,815, 1.1%) experienced significantly higher rates of any stroke (27.1/100,000 versus 9.1/100,000), ischemic stroke (9.9/100,000 versus 3.3/100,000), subarachnoid haemorrhage (7.4/100,000 versus 1.6/100,000), intracerebral haemorrhage (7.4/100,000 versus 2.0/100,000), and cerebral venous thrombosis (7.4/100,000 versus 2.7/100,000) in comparison to non-ART users.
• Following IPW analysis, ART was associated with increased odds of any stroke (aOR 2.14).

"Using population-level data among women hospitalized for delivery in the United States, we found an association between ART and stroke after adjustment for measured confounders," the researchers concluded.

Reference:

Dicpinigaitis AJ, Seitz A, Berkin J, Al-Mufti F, Kamel H, Navi BB, Pawar A, White H, Liberman AL. Association of Assisted Reproductive Technology and Stroke During Hospitalization for Delivery in the United States. Stroke. 2024 Feb 1. doi: 10.1161/STROKEAHA.124.046419. Epub ahead of print. PMID: 38299332.