Women who give birth to babies conceived by in-vitro fertilisation (IVF) are at increased risk of experiencing long-term symptoms of gastro-oesophageal reflux disease (GORD), according to the results of a study published in the UEG Journal.1 Researchers in Turkey compared two groups of women who had given birth to their first child at least 1 year earlier and found that those who had had IVF were three-times more likely to be diagnosed with GORD than those who had conceived naturally. No differences in GORD prevalence were reported between the women who had IVF and gave birth to single babies and those who gave birth to twins.
GORD and pregnancy
Gastro-oesophageal reflux disease (GORD) is a common condition in which acid from the stomach travels up into the oesophagus and causes heartburn, regurgitation and pain when swallowing. The most common cause of GORD is a weakening of the lower oesophageal sphincter (LOS) (the ring of muscle at the end of the oesophagus), allowing the stomach acid to leak up into the oesophagus and damage the lining. Pregnancy is a known risk factor for the development of GORD, affecting around half of all pregnant women.1 Pregnancy-related GORD is generally considered to be a temporary problem, although studies suggest that having reflux symptoms during pregnancy predisposes women to having further attacks.1
IVF and GORD study
In the first study of its kind looking at the relative risk of GORD in women who conceive using IVF, 156 first-time mothers who had had twins (n=54) or single babies (n=102) at least 1 year earlier after IVF treatment were interviewed face-to-face to collect data on their pregnancies and any GORD symptoms experienced using a validated reflux questionnaire.1 A diagnosis of GORD was made if heartburn, regurgitation or both occurred at least once a week. Data from this group of women were then compared with an age-matched control group of women who had conceived naturally and had completed the same diagnostic questionnaire for GORD during another study.
The prevalence of GORD at the time of data collection was found to be 13.5% in the group of women who had received IVF compared with just 4.5% in the group of women who had conceived naturally (p=0.015). In the IVF group, the prevalence of GORD was slightly higher in women who gave birth to twins (14.8%) compared with those who gave birth to single babies (12.7%), but the difference was not statistically significant.
The reasons why women who have IVF might be more prone to developing GORD are not clear. The study authors propose a number of possibilities, including medications taken during IVF (e.g. high-dose progesterone and oestrogen) that relax the LOS, psychological causes associated with fertility issues (e.g. stress, depression and anxiety), and the possibility that women who undergo IVF may spend long periods of time lying down for fear of miscarriage.
"These are very interesting findings and UEG would welcome further research in this area to determine whether these results can be replicated in long-term, prospective studies," said Dr. Oliver Pech, Head of Gastroenterology and Interventional Endoscopy at the St. John of God Hospital in Regensburg in Germany and Associate Editor of the UEG Journal. "If so, we really need to investigate how we might prevent the development of GORD in all pregnant women, but particularly in those who receive IVF treatment."