Infertility history is associated with decreased midlife cardiovascular health (CVH), according to a recent study published in JAMA Network Open.
Takeaways
- There is an association between a history of infertility and decreased cardiovascular health (CVH) in midlife among female individuals.
- Approximately 15% of opposite-sex couples seeking childbirth experience infertility. Infertility not only affects reproductive health but also leads to various physical, psychological, and social health challenges.
- While increasing age remains the primary factor linked with infertility, early experiences of infertility might correlate with cardiometabolic health issues later in life.
- The study analyzed data from the Project Viva pregnancy cohort, consisting of pregnant individuals from the metropolitan Boston area between 1999 and 2002. The Life’s Essential 8 framework was utilized to evaluate cardiovascular health, considering both behavioral and biomedical factors.
- Participants with a history of infertility were generally older, more frequently non-Hispanic White, college-educated, and had higher household incomes. Their cardiovascular health scores, especially in the biomedical domain, were notably lower than those without infertility history.
Approximately 15% of opposite-sex couples seeking childbirth experience infertility. Infertility is associated with multiple adverse physical, psychological, and social health outcomes, many of which may disproportionately impact marginalized populations because of disparities in access to fertility care.
Data has indicated an association between reproductive health and cardiovascular risk factors. Increasing age is the primary factor associated with infertility, but early infertility may be associated with cardiometabolic outcomes later in life.
Determining an association between infertility and CHV would improve screening and prevention efforts before disease onset. Investigators conducted a study to evaluate this association.
Data was obtained from the Project Viva pregnancy cohort, which included pregnant patients with health insurance or Medicaid residing within the metropolitan Boston area at under 22 weeks’ gestation between 1999 and 2002. Characteristics were assessed at enrollment and a midlife follow-up visit conducted between 2017 and 2021.
Exclusion criteria included missing primary exposure data and Life’s Essential 8 (LE8) domain prohibiting aggregate score calculation. Infertility history was determined from an enrollment questionnaire, index pregnancy medical records, and a midlife questionnaire. Investigators defined infertility as, “12 or more months, or 6 or more months if aged 35 years or older, of attempts to conceive.”
The LE8 categorizes 8 factors of CVH into 2 domains. Diet, physical activity, sleep health, and smoking status are included in the behavioral domain, while weight, blood pressure, blood lipids, and glycemia are included in the biomedical domain.
Overall LE8 scores for each domain were measured from 0 to 100 points. Scores of 80 to 100 were considered high CVH, 50 to 79 moderate, and 0 to 49 low. Covariates included race and ethnicity, body size, annual household income, age at menarche, and education level.
There were 468 participants included in the final analysis, 73.8% of whom were college graduates, 26.8% had ever smoked, and 66.4% had an annual household income above $70,000. A history of infertility was reported in 34.2% of patients, and mean LE8 scores were 76.3 overall, 76.5 behavioral, 76 biomedical, and 78.9 for blood biomarkers.
Patients with infertility were older at the midlife visit and were more often non-Hispanic White, had a college degree, and had an annual household income above $70,000 than those without infertility. These patients had an overall lower LE8 score by 2.94 points, biomedical by 4.07, and blood subdomain by 5.98. The behavioral domain score was reduced by 1.81 points in participants with infertility.
These results indicated an association between infertility history and decreased CVH. Investigators concluded infertility history should be considered when assessing risk in female patients.
Reference
Nichols AR, Rifas-Shiman SL, Switkowski KM, et al. History of infertility and midlife cardiovascular health in female individuals. JAMA Netw Open. 2024;7(1):e2350424. doi:10.1001/jamanetworkopen.2023.50424
