Association Between Prepregnancy Blood Pressure and Reproductive Outcomes of In Vitro Fertilization

The latest updated 2025 and 2017 American College of Cardiology and the American Heart Association guidelines lowered the diagnostic threshold for hypertension to 130/80 mm Hg. Whether the new classification for hypertension has implications for reproductive outcomes remains uncertain.

This retrospective cohort study was conducted at the Reproductive Medicine Center of Shandong University in China. Women who underwent the initial embryo transfer of their first in vitro fertilization cycle were categorized into the normal blood pressure (BP), elevated BP, stage 1 hypertension, and stage 2 hypertension groups based on BP levels measured just before in vitro fertilization treatment. We examined associations of prepregnancy BP and reproductive outcomes.

This study included 43 629 women who received in vitro fertilization treatment. The rate of live birth was lower in women with stage 1 and stage 2 hypertensions (46.1% and 41.4%, respectively) compared with women with normal BP (49.2%), with the adjusted relative ratios of 0.97 (95% CI, 0.937-0.996; P=0.027) and 0.91 (95% CI, 0.85-0.98; P=0.009), respectively. Compared with normal BP, both stage 1 and stage 2 hypertension were associated with higher risks of pregnancy loss, preeclampsia, and preterm delivery. Elevated BP was associated with a higher risk of gestational hypertension. Optimal BP cutoffs for adverse reproductive outcomes were consistent with the diagnostic threshold for stage 1 hypertension.

Compared with normal BP, prepregnancy stage 1 and stage 2 hypertension were associated with a lower rate of live birth after in vitro fertilization treatment and increased risks of pregnancy complications.