As doulas, we are non-clinical pregnancy, birth, and postpartum support providers. However, with 1.5% of babies being conceived via IVF, it is important to be aware of how IVF can impact pregnancy. Upwards of 40% of IVF cycles result in frozen embryos, it is important to be aware that frozen embryo transfers (FET) have risks. Research shows FET pregnancies and high blood pressure may be related.
As doulas, we do not need to be aware of all medical scenarios. In fact, most pregnancies unfold quite well. However, it is important we have the necessary information to support our clients. In some metro areas, upwards of 5% of babies are conceived via IVF. In states where IVF is mandated to be covered by insurance, the numbers could be higher.
Given the frequency of IVF, most doulas will eventually support clients who have conceived via IVF. As a professional doula, it is important you have the information to provide adequate support.
New research shows a potential connection between FET pregnancies and high blood pressure. As doulas, knowing this can help us educate our clients and encourage them to discuss these risks with their midwives or doctors.
FET Pregnancies and High Blood Pressure
An increase in blood pressure can be a common side effect of pregnancy due to hormone shifts. However, when it reaches a certain point, it becomes hypertension – or high blood pressure. This increases pregnancy and birth complications for both mother and baby.
Given that cardiovascular events are a leading cause of complications, all pregnant people are screened and monitored. However, those with specific risk factors might have additional monitoring.
Currently, approximately 1 in 25 US pregnancies are complicated with hypertension. The research published in Hypertension, an American Heart Association journal, found FET may be associated with a 74% increased risk of hypertensive disorders.
Surprisingly, the study found fresh embryo transfers shared a similar risk of hypertensive disorders as naturally conceived pregnancies.
Frozen embryo transfers are done in a different cycle than a full IVF cycle where eggs are retrieved. With a fresh transfer, the embryos are transferred three or five days after egg retrieval rather than a separate cycle.
What Are The Risks of Hypertensive Disorders During Pregnancy?
Hypertensive disorders increase risks for both the birthing person and the baby. While they are often managed well, the risks exist and can cause problems such as:
Complications from high blood pressure for the mother and infant can include the following:
- For the birthing person: preeclampsia, eclampsia, stroke, medically necessary induction, early c-section, placental abruption (which increases risk of hemorrhage).
- For the baby: birth before 37 weeks, low birth weight, IUGR, and complications associated with preterm birth and low birth weight – hypertension can impact blood flow to the placenta and thus the baby
As doulas, we will not be diagnosing or treating clients for hypertensive disorders. Neither should we give them worst case scenario and scare them about risk factors. However, we can use our information to encourage adequate prenatal care. Also, discussing concerns with their medical provider, and encourage them to be self-advocates when they have concerns.
We can also support them with stress management, nutrition, and problem-solving ways to get adequate rest.
What Did The Study Find?
Researchers took a unique sibling comparison approach to differentiate whether the risk factor was the parents or the type of conception. Those included in the study have a previous naturally conceived birth, as well as either an FET or fresh IVF transfer.
Sindre H. Petersen, M.D., the study’s lead author and a Ph.D. fellow at the Norwegian University of Science and Technology in Trondheim, Norway, and her colleagues, examined national data from medical birth registries from Denmark, Norway, and Sweden. They looked at nearly 2.4 million women who were ages 20 to 44 years old who had single deliveries and gave birth during the study period from 1988 through 2015.
They found:
- Of those analyzed, women with a pregnancy resulting from an FET were 74% more likely to develop a hypertensive disorder during pregnancy compared to those who conceived naturally.
- Of those who had both a natural conception and an FET, the risk of hypertensive disorders in pregnancy after FET was twice as high compared to their naturally conceived pregnancies.
- Pregnancies from a fresh IVF cycle did not have a higher risk of developing hypertensive disorders compared to a natural conception.
“Our sibling comparisons indicate that the higher risk is not caused by factors related to the parents, rather, however, that some IVF treatment factors may be involved,” Petersen said. “Future research should investigate which parts of the frozen embryo transfer process may impact risk of hypertension during pregnancy.”
What does this mean for doulas? In short, if you have a client who shares they are pregnant via an FET your knowledge helps. It is important to help encourage they keep all prenatal appointments. You can encourage them to follow provider recommendations. Also, share general education regarding lifestyle and diet options which might aid in reducing their risks.
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...