By Dr Pensee Wu, Senior Lecturer, Honorary Consultant Obstetrician and Subspecialist in Maternal Fetal Medicine. This article first appeared as a Personally Speaking column in the Stoke Sentinel in May 2022.

Heart disease is a major health issue in Staffordshire, where heart and circulatory disease kill one in four people. Every three hours someone dies from a heart or circulatory disease in Staffordshire. Even in pregnancy, heart and circulatory disease is the leading cause of maternal death.

Being a Consultant Obstetrician at the University Hospital of North Midlands who looks after women with high-risk pregnancies, my research at Keele University focuses on the link between high-risk pregnancies and heart disease. Recently, my research team studied pregnancies which were conceived using assisted reproductive technology. We found women who conceived with ART are at a higher risk of vascular and pregnancy complications.

Fertility problems affects around 1 in 7 couples in the UK and many couples are turning to assisted reproductive technology, such as in vitro fertilisation (IVF) to help them to conceive. So far, assisted reproductive technology has contributed to the birth of more than 5 million babies worldwide.

Our study looked at more than 106,000 pregnancies in which the baby was conceived with assisted reproductive technology and compared these to more than 34 million pregnancies conceived without fertility treatment in the US between 2008 and 2016. We discovered that women who conceived with assisted reproductive technology were more than twice as likely to suffer kidney failure and have a 65 per cent higher risk of an irregular heartbeat. These women also have a 57 per cent higher risk of placental abruption, when the placenta comes away from the inside of the womb wall before giving birth. They were also 38% more likely to have caesarean deliveries, and 26 per cent. more likely to have the baby born prematurely.

We found women who conceived with assisted reproductive technology were on average older than those who conceived spontaneously, with a median age of 35 years old compared to 28 years old. They also had more pre-existing health conditions, including obesity and cardiovascular disease. However, even when women had no pre-existing heart diseases, women who conceived with assisted reproductive technology still had increased risks of vascular and pregnancy complications. Therefore, it is important for healthcare professionals to tell women about these associated complications before women undergo treatment using assisted reproductive technology.

Previously we also studied cancer in pregnancy, another high-risk pregnancy group. Cancer is the commonest cause of mortality in women of reproductive age in the UK. Stoke-on-Trent figures show that for every 100,000 people, 313 in Stoke-on-Trent died of cancer which is higher than the national average of 260 per 100,000 people.

We studied over 43 million pregnancies in the US between 2004 and 2014 and showed haematological, thyroid, and cervical cancers were the 3 most common types of cancer. Most of the cancer types were associated with preterm birth. Haematological cancers were linked with particularly high risks of in-hospital complications. These include four-fold increased risk of irregular heartbeat, seven-fold increased risk of maternal death, and 12-fold increased risk of peripartum cardiomyopathy, a condition where the heart becomes enlarged and weakened in late pregnancy or following childbirth.

Cervical cancer was associated with the highest odds for acute kidney injury. Skin cancer was most associated with an increased risk of stroke. In turn, breast cancer was associated with the highest odds of giving birth prematurely. In addition, metastases, the spread of cancer around the body, also increased the risk of preterm birth and maternal death.

By increasing awareness amongst healthcare professionals of the possible complications posed to these women, our study can help to improve outcomes for pregnant women who are at a higher risk of complications due to having cancer.

Through my research at Keele University and my clinical work at University Hospital of North Midlands, I hope to help pregnant women reduce birth complications, improve pregnancy outlook, as well as prevent heart and circulatory disease in their future.