Association of Assisted Reproductive Technology and Stroke During Hospitalization for Delivery in the United States

Authors

Alis J. Dicpinigaitis, Department of Neurology, New York Presbyterian - Weill Cornell Medical Center, New York, NY (A.J.D., A.S., H.K., B.B.N., A.P., H.W., A.L.L.).
Alison Seitz, Department of Neurology, New York Presbyterian - Weill Cornell Medical Center, New York, NY (A.J.D., A.S., H.K., B.B.N., A.P., H.W., A.L.L.).
Jill Berkin, Department of Obstetrics, Gynecology, and Reproductive Sciences, Mount Sinai Hospital, New York, NY (J.B.).
Fawaz Al-Mufti, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla (F.A.-M.).
Hooman Kamel, Department of Neurology, New York Presbyterian - Weill Cornell Medical Center, New York, NY (A.J.D., A.S., H.K., B.B.N., A.P., H.W., A.L.L.).
Babak B. Navi, Department of Neurology, New York Presbyterian - Weill Cornell Medical Center, New York, NY (A.J.D., A.S., H.K., B.B.N., A.P., H.W., A.L.L.).
Anokhi Pawar, Department of Neurology, New York Presbyterian - Weill Cornell Medical Center, New York, NY (A.J.D., A.S., H.K., B.B.N., A.P., H.W., A.L.L.).
Halina White, Department of Neurology, New York Presbyterian - Weill Cornell Medical Center, New York, NY (A.J.D., A.S., H.K., B.B.N., A.P., H.W., A.L.L.).
Ava L. Liberman, Department of Neurology, New York Presbyterian - Weill Cornell Medical Center, New York, NY (A.J.D., A.S., H.K., B.B.N., A.P., H.W., A.L.L.).

Author Type(s)

Faculty

Journal Title

Stroke

First Page

999

Last Page

1005

Document Type

Article

Publication Date

4-1-2024

Department

Neurology

Abstract

INTRODUCTION: Infertility treatment with assisted reproductive technologies (ARTs) has been associated with adverse vascular events in some but not all previous studies. Endothelial damage, prothrombotic factor release, and a higher prevalence of cardiovascular risk factors in those receiving ART have been invoked to explain this association. We sought to explore the relationship between ART and stroke risk using population-level data. METHODS: We conducted a retrospective cohort study using data from the National Inpatient Sample registry from 2015 to 2020, including all delivery hospitalizations for patients aged 15 to 55 years. The study exposure was use of ART. The primary end point was any stroke defined as ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, or cerebral venous thrombosis during index delivery hospitalization. Individual stroke subtypes (ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral venous thrombosis) were evaluated as secondary end points. Standard , Clinical Modification algorithms were used to define study exposure, comorbidities, and prespecified end points. In addition to reporting population-level estimates, propensity score adjustment by inverse probability weighting was used to mimic the effects of randomization by balancing baseline clinical characteristics associated with stroke between ART and non-ART users. RESULTS: 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 hemorrhage (7.4/100 000 versus 1.6/100 000), intracerebral hemorrhage (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 (all <0.001 for all unadjusted comparisons). Following inverse probability weighting analysis, ART was associated with increased odds of any stroke (adjusted odds ratios, 2.14 (95% CI, 2.02-2.26); <0.001). CONCLUSIONS: Using population-level data among patients hospitalized for delivery in the United States, we found an association between ART and stroke after adjustment for measured confounders.

Recommended Citation

Dicpinigaitis, A. J., Seitz, A., Berkin, J., Al-Mufti, F., Kamel, H., Navi, B. B., Pawar, A., White, H., & Liberman, A. L. (2024). Association of Assisted Reproductive Technology and Stroke During Hospitalization for Delivery in the United States. Stroke, 55 (4), 999-1005. https://doi.org/10.1161/STROKEAHA.124.046419