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
One in eight mothers diagnosed with gestational diabetes, research finds

One in eight mothers in England is now diagnosed with gestational diabetes, after diagnoses of the condition rose by 60 per cent in just five years, according to a major study.
The research found that rates of gestational diabetes increased from around 8 per cent of pregnancies in 2018 to more than 12 per cent in 2022.
Gestational diabetes mellitus (GDM) develops when the body cannot produce enough insulin to regulate blood sugar levels during pregnancy.
It is the most common complication to occur during pregnancy and is associated with a heightened risk of preterm birth, emergency caesarean section, and babies being born either larger or smaller than expected for their gestational age.
The condition is also linked to longer-term health risks for both mothers and their children.
Laura Magee is professor of women’s health at King’s College London and co-investigator on the study.
She said: “Pregnancy outcomes for women with gestational diabetes are still worse than those for women without gestational diabetes.
“Further work is required to address how control of blood sugar and timed birth can address the excess of adverse pregnancy outcomes, compared with the general maternity population.
“Follow-up after birth is also essential, as women with prior gestational diabetes are at increased risk of cardiometabolic disease, including type 2 diabetes mellitus, but also high blood pressure and elevated blood cholesterol, starting within the first year after birth.”
For the study, researchers analysed routinely collected NHS maternity data covering more than 2.3 million mothers and around 2.8 million births across 184 hospitals in England between 2018 and 2022, making it one of the largest investigations of its kind.
The study uncovered marked inequalities in both the prevalence of gestational diabetes and pregnancy outcomes more broadly.
The sharpest rises in diagnoses were recorded among Asian women, among whom rates reached around 23 per cent, and among women living in the most deprived areas, where rates climbed to about 14 per cent.
The disparities extended beyond gestational diabetes.
Black mothers were found to be more likely to experience an emergency caesarean birth, women in deprived areas were more likely to give birth prematurely, and Asian mothers were more likely to have babies born small for their gestational age.
Among these higher-risk groups, researchers found that a diagnosis of gestational diabetes further compounded the risk of preterm birth.
Rising maternal age, increasing rates of obesity and improvements in how data is captured by the NHS are all likely to be contributing to the growing prevalence of the condition, the researchers said.
Notably, they found that changes to gestational diabetes screening introduced during the Covid-19 pandemic did not meaningfully affect the overall upward trend in diagnoses, suggesting the rise reflects genuine underlying changes in the population rather than shifts in testing practice.
The researchers said the findings pointed to an urgent need to strengthen maternity services and improve support for the women at greatest risk.
Experts said the findings also carried implications that extend well beyond pregnancy itself.
Dr Sonya Babu-Narayan, clinical director at the British Heart Foundation, said the study was part of a wider pattern of research using large-scale health data to uncover hidden risks.
“Big data research studies like this, which can now analyse millions of healthcare records, are uncovering a concerning rise in conditions which raise people’s chances of having a future heart attack or stroke,” she said.
“Gestational diabetes often goes away after pregnancy, but it can increase women’s risk of future cardiovascular disease.”
Dr Babu-Narayan called on healthcare professionals to routinely ask women about pregnancy-related risk factors, regardless of how long ago the pregnancy took place.
“Healthcare professionals who want to fully understand people’s risk of heart attack and stroke should routinely ask women about risk factors unique to them, such as diabetes or high blood pressure in pregnancy – even if that pregnancy was decades earlier,” she said.
“If you are a woman who has had diabetes or high blood pressure during pregnancy, it is especially important to attend health checks when invited.”
Motherhood
Parenthood impacts women’s health more than men’s, research finds

Parenthood is associated with changes in women’s health that are not seen in men, including reduced exercise and differences in wellbeing, new research has revealed.
Men’s health indicators varied only slightly depending on whether they were fathers, while the number and age of children were linked to changes in women’s health.
Anna Barbuscia, of the OPIK research group at the EHU-University of the Basque Country, said sharing parental responsibilities more equally could help reduce these differences.
Having children can bring significant biological, psychological and social changes, but the study found that the effects varied considerably between women and men.
Barbuscia said: “Having children has greater consequences for the health of the mother, both in the short and long term.
“This is not only because of the biological changes as a result of the pregnancy and birth, but also the psychological consequences. Our findings show a significant gender gap.”
The study, carried out by the OPIK research group, examined the relationship between motherhood and fatherhood and several health indicators.
These included psychological wellbeing, perceived health, physical exercise, alcohol consumption and smoking.
The researchers also considered whether the number and age of participants’ children influenced these indicators.
“It was observed that, in men, neither the fact of being a father, nor family characteristics, affected the health indicators. All parameters remained practically the same,” said Barbuscia.
The findings showed a different pattern among women, with the number and age of their children associated with changes in health and wellbeing.
Mothers with only one child and those with adolescent children reported more depressive symptoms.
Women living with two or more young children reported a better perception of their overall health.
“Caring for younger children usually demands greater physical effort, which may result in increased tiredness and poorer quality sleep.
“Adolescence, on the other hand, has traditionally been considered the most stressful phase for both mothers and fathers,” Barbuscia said.
The study also found a significant gender difference in physical activity.
Women generally did less regular physical exercise than men, and the gap widened when they had children.
“Only 16 per cent of mothers with young children do regular exercise, compared to 30 per cent of women who do not have children.
“In men, however, again, there was scarcely any difference between those who are fathers and those who are not,” Barbuscia said.
“This all indicates that maternity reduces the time available for personal care, which has an impact on a habit as important for health as physical activity.”
Barbuscia said the findings should be considered when designing family policies and planning healthcare services.
“Facilitating work-family balance is not enough. It is also necessary to ensure that mothers have time to look after their own health and wellbeing. Investing in this time is investing in health.”
She added that sharing parental responsibilities more equally between mothers and fathers could help reduce the inequalities observed.
“If we want to build healthy families and encourage people to have children, we need to start by ensuring that raising children does not have such an unequal impact on men and women.”
Insight
Rising number of young midwives quitting NHS due to burnout

More young midwives are leaving the NHS before 35 as burnout adds pressure to stretched maternity services, new research has revealed.
The trend has raised concerns about the quality and safety of care for mothers and babies in understaffed maternity units.
During 2025-26, 1,669 midwives aged 34 or under left the health service in England, representing 57 per cent of the 2,949 midwives of all ages who resigned.
The pressures of maternity care, including increasingly complex childbirth and the risks involved, are thought to be among the factors behind the trend.
Hannah Leonard, deputy chief midwife at the Royal College of Midwives, said the exodus of midwives under 35 was “deeply worrying” and showed that too many were ending up “burnt-out within a few years of qualifying because every shift means too few colleagues, missed breaks and unpaid hours”.
She added: “Losing these midwives, and students, even before they qualify, is a terrible waste of talent.”
The figures, revealed in parliamentary questions tabled by the Liberal Democrats, show that 205 of last year’s younger leavers were under 25, while 655 were aged 25 to 29 and 809 were aged 30 to 34.
The number of midwives under 35 leaving the NHS has risen sharply in recent years. The 2025-26 figure was 59 per cent higher than the 1,051 who left in 2014-15, according to NHS figures.
Burnout means long-term physical and emotional exhaustion, often linked to sustained pressure at work.
Separate figures obtained by the Liberal Democrats suggest almost one in four midwifery students are leaving before completing their three-year degree.
In 2021, 3,565 students started a midwifery degree, but 2,725 graduated in 2024, meaning 840, or 24 per cent, did not complete the course.
Midwifery students spend much of their second and third years learning on the job in maternity units.
The loss of staff and students underlines what the Royal College of Midwives has described as a “staffing emergency” in maternity care across the UK.
A recent survey by the Royal College of Midwives found that three-quarters of midwives had considered leaving the profession over the last year, mainly because of concerns over staffing levels and patient safety.
Both recent large-scale reviews of maternity care in England, led by Donna Ockenden and Valerie Amos, identified staffing shortages as a key problem affecting patient safety.
Helen Morgan, the Liberal Democrat health spokesperson, said: “These statistics reveal an alarming crisis in maternity, with far too many midwives burning out early in their career and in their training. Patients are paying the price, and mothers are left with no alternative but to give birth on understaffed and unsafe wards.
“Rather than throw money at yet more new recruits who quit under intolerable pressure, the government needs a new approach. Through guaranteeing protected, year-round training and professional development we can help midwives cope with rising complexity and risk.”
About 10 per cent of all midwives leave the NHS each year.
However, the figures show higher leaving rates among younger midwives, with one in seven, or 14.6 per cent, of those aged 25 to 29 and one in six, or 16.6 per cent, of those aged 30 to 34 leaving during 2025-26.
A Department of Health and Social Care spokesperson said: “Under this government we have a record number of midwives in the workforce and we value the vital service they provide in maternity and neonatal units across the country.
“To make the NHS the best employer it can be, we have introduced new NHS staff standards to improve health and wellbeing support, promote flexible working, as well as crucial measures to tackle violence, sexual harassment or abuse and racism.
“Alongside consecutive above-inflation pay rises, we’ve bolstered the midwifery workforce through our graduate guarantee and recently opened up 1,000 more midwifery roles backed by £10m to help prevent student midwives leaving the profession.”
Department of Health and Social Care figures show a record 25,500 full-time-equivalent midwives are working in the NHS, 2,000 more than when the Labour government took office in July 2024.
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