Motherhood
Frozen embryo transfers in IVF linked to greater risk of maternal hypertension
Implications rise with increasing use of embryo freezing in assisted reproduction

Concerns have been raised that pregnancies derived from frozen embryo transfers in IVF might increase the maternal risk of hypertensive disorders.
Pre-eclampsia is one such condition that causes high blood pressure during pregnancy and after labour and which may have severe consequences for both the mother and the foetus.
The concerns have been raised in recent observational studies comparing the outcomes of fresh and frozen transfers, which, by definition, are subject to statistically confounding variables. Sibling comparisons can remove much of this confounding.
The extensive study based on real-life registry data and a comparison of maternal complications in sibling pregnancies indicate that pregnancies following frozen embryo transfer (FET) do indeed have a substantially higher risk of hypertensive disorders than naturally conceived pregnancies.
This same raised risk was also found in a sub-group analysis of sibling births, which was designed to eliminate the effect of any parental factors in the results.
“Our findings are important because the number of FETs is rapidly increasing throughout the world,” says the study’s first author, Dr Sindre H. Petersen from the Norwegian University of Science and Technology.
He has presented the study results at the 38th annual meeting of ESHRE in Milan on behalf of the Committee of Nordic Assisted Reproductive Technology and Safety group which monitors the health of mothers and children born after assisted reproduction in the Nordic countries.
According to the latest registry report from ESHRE, the proportion of FET cycles relative to fresh is still on the rise in Europe. In 2017 the proportion was 49 per cent, against 38 per cent in 2014. Similar trends are present in the US and most high-income countries.
FETs are increasingly common because of improved cryopreservation methods, facilitation of single embryo transfer, reduction of ovarian hyperstimulation, and the elective freezing of all embryos.
The study analysed more than 4.5 million singleton pregnancies in the registries of three Nordic countries with delivery between 1988 and 2015. Of the conceptions following assisted reproduction, 78, 300 were after fresh embryo transfer and 18,037 were after FET.
The registry birth references – largely unique to the Nordic countries – also allowed the identification of 33,209 sibling deliveries following either fresh or frozen embryo transfer, and natural conception.
“This study was by far the largest sibling analysis to date investigating the association between assisted reproduction treatments and hypertensive disorders in pregnancy,” Dr Petersen adds.
Results of the study showed that the risk of hypertensive disorders in pregnancy were almost twice as high in the pregnancies following FET that in pregnancies following a natural conception. However, the risk of hypertensive disorders in pregnancies following fresh embryo transfer pregnancies was comparable to naturally conceived pregnancies.
Hypertensive disorders in pregnancy comprise gestational hypertension and pre-eclampsia, and the more rare but severe conditions of eclampsia and Hemolysis-Elevated-Liver-enzymes-Low-Platelets (HELLP) syndrome.
Adjustments for maternal body mass index, smoking and time between deliveries did not affect the end results, nor did other methods of assisted reproduction (IVF, ICSI, duration of embryo culture or number of embryos transferred).
Dr Petersen says that the design of the study was not able to assess the relative merits of embryo freezing against the higher risk of hypertensive disorders, but notes that “cryopreservation has facilitated the highly favourable single embryo transfer approach, improving foetal and maternal outcomes by avoiding multiple pregnancies”.
Recent studies have suggested that the risk of hypertensive disorders in FET pregnancies may be associated with therapies to prepare the uterus for embryo implantation. These are usually given in the form of hormone replacement therapy in what has become known as a ‘programmed’ or ‘artificial’ cycle – in which there is no naturally developing corpus luteum to provide hormonal support for the pregnancy.
The presence of a corpus luteum – a mass of cells that forms in an ovary responsible for the production of the hormone progesterone during early pregnancy – is one potentially important difference between natural conception and fresh embryo transfers, on the one hand and FETs, on the other, says Petersen.
He adds: “In our analysis all natural conceptions and fresh embryo transfer pregnancies had a corpus luteum, while a subset of the FET pregnancies did not.
“However, we expect from previous Danish and Swedish publications that in our study, only 15-30 per cent of FET pregnancies were in artificial cycles, which seems unlikely to drive the entirety of the strong association in our results.
“It thus seems possible that some inherent aspect of the freezing and thawing process, for example epigenetic changes, might be responsible as well.”
The doctor has pointed out that it is too early to recommend changes to treatment strategies based solely on this study, and that there are still good reasons why frozen embryo transfers are increasingly used, especially in their facilitation of single embryo transfer.
“I am confident that a well-grounded and individualised decision of whether to go for a fresh or a frozen cycle can be made after dialogue between the clinician and the couple,” he concludes.
“Our study can contribute to informed decision-making for patients and clinicians.”
Motherhood
Health Secretary announces inquiry into Leeds maternity services

An independent inquiry will be launched into Leeds maternity services following a parent-led campaign over care failures stretching back 14 years.
Health secretary Wes Streeting said he was deeply concerned about problems at Leeds Teaching Hospitals NHS Trust, calling it “a real outlier” for perinatal mortality — deaths around the time of birth — compared with other hospitals nationally.
The announcement follows maternity services at the trust being rated “inadequate” after an unannounced Care Quality Commission inspection in December and January.
A subsequent NHS England report raised “significant” concerns about safety and quality of care.
After meeting affected parents in the city, Streeting said the trust — which runs maternity units at Leeds General Infirmary and St James’s Hospital — required scrutiny similar to the ongoing Nottingham maternity inquiry.
“I’ve decided that we need a Nottingham-style independent inquiry into what’s going on with maternity and neonatal services in Leeds,” he said.
“I think we need clear answers, accountability and improvement… I do think we need that independent look, not just for what’s happening now but stretching back to historic cases as well.”
The Nottingham review — the largest maternity inquiry of its kind — has examined hundreds of baby deaths and injuries at Nottingham University Hospitals.
It has led to the NHS paying out tens of millions of pounds for claims dating back to 2006 and prompted a police investigation, with findings expected next year.
Dozens of baby deaths in Leeds in recent years are thought to have been preventable.
Families affected by avoidable deaths of babies or mothers have long campaigned for an independent investigation.
Streeting has already commissioned a national review of NHS maternity services but said Leeds was an “exceptional case” that warranted its own inquiry.
“I don’t want to drown the NHS across the country in a whole series of local reviews into what I think is a national problem,” he said.
“But I have been persuaded, having been to Leeds recently to listen to families and look at the data.
“Given the challenges still evident — not least from the most recent Care Quality Commission inspection — and Leeds’s scale as one of the largest teaching hospitals in Europe, I think all of those things point to Leeds as an exceptional case for this kind of inquiry.”
He said details of the inquiry’s scope would be announced soon.
“I’ll proceed without fear or favour. If there are individuals who need to be held to account, I will ensure accountability.
“Where systemic improvements are needed, I will make sure they happen, and that’s why I believe this specific investigation is necessary.”
Campaigners welcomed the decision, describing the current system as “rotten”.
Fiona Wisner-Ramm and Daniel Ramm, whose daughter Aliona died 27 minutes after birth in 2020 following what an inquest described as “gross failures” in care, have been among those leading the campaign.
“This means that Leeds Teaching Hospitals NHS Trust will now be properly investigated, allowing for meaningful changes to its culture and practices,” they said in a statement.
“We hope that this inquiry will finally break the cycle of repeated errors and inadequate leadership, helping to prevent further deaths and injuries to mothers and babies.”
News
Protective immune cells in breastfeeding women guard against breast cancer, research finds

Women who breastfeed develop protective immune cells that help guard against breast cancer, with effects lasting for more than 30 years, new research shows.
The study found that specialised T-cells — immune cells that fight disease — remain in breast tissue long after pregnancy and provide lasting protection, particularly against triple-negative breast cancer, one of the most aggressive forms.
Observations dating back to the 18th century, when physicians noticed nuns had some of the highest rates of breast cancer, first hinted that childbearing and breastfeeding could protect against the disease.
Modern research has confirmed this link, though the biological explanation was unclear.
Professor Sherene Loi is senior author and clinician scientist at the Peter MacCallum Cancer Centre.
The researcher said: “The key take-home messages are that pregnancy and breastfeeding will leave behind long-lived protective immune cells in the breast and the body, and these cells help to reduce risk and improve defence against breast cancer, particularly triple-negative breast cancer, but potentially other cancers as well as disease.”
Researchers from the Peter MacCallum Cancer Centre in Melbourne studied non-cancerous breast tissue from more than 260 women who had undergone breast reduction or preventive surgery.
They found that women who had given birth had more specialised immune cells called CD8⁺ T-cells — part of the adaptive immune system that targets specific threats, including cancer.
The team then tested whether these cells directly provided protection.
In mice, cancer cells implanted into breast tissue grew less in those that had pups and breastfed compared with those that had not. When the researchers removed the T-cells from the nursing mice, the protective effect disappeared.
The researchers also analysed data from more than 1,000 breast cancer patients diagnosed after childbirth with available breastfeeding records.
Women who had breastfed had better outcomes from triple-negative breast cancer than those who had not. Their tumours also contained more immune cells, suggesting ongoing immune activity against the cancer.
The study provides an explanation for why breastfeeding appears protective, and the findings could help inform new strategies for women unable to have children or breastfeed.
Understanding the underlying biology may aid development of vaccines or therapies that mimic this natural defence.
Professor Loi said: “The effects are really quite small for every individual, but population-wide the effects are large.”
She stressed that breastfeeding does not guarantee protection against breast cancer, noting it is “not a 100 per cent guarantee that they won’t get breast cancer.”
The study also explored why some breast cancers contain high numbers of specialised immune cells while others do not.
Patients with more of these cells generally had better outcomes, particularly with triple-negative breast cancer.
Professor Loi explained that T-cells react not only to viruses or bacteria but also to cancer, describing this response as “one of our very modern therapeutic weapons against cancer.”
Associate Professor Wendy Ingman from the University of Adelaide’s Medical School said longer breastfeeding duration provided greater benefits.
Each year of breastfeeding is linked to a 4 per cent lifetime reduction in the mother’s breast cancer risk.
“This study shows that having babies and breastfeeding causes long-lasting changes in immune cells that could help protect the breast from cancer,” Ingman said.
“I’m hopeful that this type of research will lead to new approaches to reduce women’s breast cancer risk.”
Motherhood
Psilocybin may make postpartum depression worse, study finds

Psilocybin may heighten anxiety and depression in new mothers rather than help treat postpartum mental health conditions, research suggests.
Scientists found that giving mouse mothers the psychedelic drug – the active compound in magic mushrooms – increased anxiety and depressive-like behaviour linked to perinatal mood disorders, which are mental health conditions that can develop during or after pregnancy.
The results challenge assumptions about psilocybin’s therapeutic use, indicating it may not be suitable for all patient groups.
David E. Olson, director of the IPN and professor of chemistry, biochemistry and molecular medicine at UC Davis, said: “The IPN has done a lot of work demonstrating that a single dose of a psychedelic can lead to long-lasting, beneficial effects.
“But it’s a little more nuanced than that in terms of who can really benefit and who might be at risk.
“There are different patient populations.”
Researchers at the University of California, Davis Institute for Psychedelics and Neurotherapeutics tested the drug in a mouse model of postpartum depression.
In this model, mothers could escape into a separate cage, mimicking the infant avoidance seen in human postpartum depression.
The negative effects persisted for two weeks after a single dose.
More concerning, pups raised by psilocybin-treated mothers also showed anxiety and depression-like symptoms into adulthood, suggesting harmful effects were passed on through lactation and altered brain development.
Co-author Danielle Stolzenberg, associate professor of psychology at UC Davis, said: “One of the things that’s discussed consistently in the clinical literature is that mums often feel like they have trouble bonding with their infants when they’re experiencing depressive symptoms.
“The mouse mums in the social stress paradigm spend significantly more time in the cage without the pups.
“They will often run back and forth to check on them but tend to actively avoid their infants for long periods of time.”
The team had expected positive results given psilocybin’s reported benefits for other mental health conditions.
“Psilocybin was of such interest for us because it’s been demonstrated to be useful across a whole host of mental disorders, including addressing anxiety and depression,” said first author Cassandra Hatzipantelis, a postdoctoral fellow at the IPN.
“We thought it could have the ability to address things that go wrong in postpartum depression, like the parent-infant connection.”
Instead, the mouse mothers continued to avoid their offspring and showed persistent symptoms even after separation.
Psilocybin-treated mice were also at higher risk of behavioural impairments and depressive-like symptoms.
Nine weeks after weaning, both male and female offspring showed heightened anxiety and depression compared with control groups.
Their brains also contained traces of psilocin, the metabolite produced when the body processes psilocybin.
“We now know that even low doses of exposure can impact offspring for long periods of time,” Stolzenberg said.
“These could be really important therapeutics, but we also realise they have limitations, and we have to conduct rigorous science to understand what those limitations are,” Olson added.
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