This cohort study examined whether the risk of hypertensive disorders of pregnancy (HDP) differs by infertility etiology and fertility treatment type (ART vs. non-ART vs. untreated) among 6,273 infertility-evaluated women compared with 10,810 unexposed women who gave birth in Quebec between 1996 and 2017.
Ovulatory disorders and tubal disease were independently associated with higher HDP occurrence; ART was associated with higher HDP risk across most infertility diagnoses; endometriosis raised HDP risk only in ART-treated pregnancies; and the ovulatory disorder–HDP link persisted regardless of treatment type or multiplicity.
Administrative health data may misclassify infertility diagnoses or HDP; the unexposed group was defined by absence of recent medical infertility history rather than confirmed fertility, introducing potential selection bias; and residual confounding from unmeasured factors (e.g., BMI, parity history) cannot be excluded.
Women conceiving via ART or with ovulatory disorders or tubal disease should be flagged as higher risk for HDP regardless of treatment path. Closer blood pressure monitoring throughout pregnancy is warranted in these groups, as the underlying biology—not just the treatment—appears to drive part of the risk.
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