Association between Preconception Hypertension in Women and Fecundability: A Systematic Review and Meta-Analysis

Cindy Sabina Faleandra (Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia)
Muhammad Khalid Jambak (Academic Health System, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia)
Linnas Ashil Hanifah Ulil Albab (Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia)
Ghefira Hasna Kamila (Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia)

Indonesian Journal of Obstetrics & Gynecology Science
Volume 9s Number 2 July 2026 Special Issue Case Report & Systematic Review

Objective: This study aimed to evaluate the association between preconception hypertension in women and fecundability.Methods: A PRISMA-guided and PROSPERO-registered (CRD420261281401) systematic review and meta-analysis was conducted. Searches were performed across databases and manual reference. Outcomes included fecundability, time to pregnancy (TTP), and infertility (TTP > 12 months). Effect estimates were pooled and reported as fecundability odds ratios (FOR), time ratios (TR), and risk ratios (RR) with 95% CIs.Results: Preconception hypertension was potentially associated with a 21% reduction in fecundability (FOR 0.79, 95% CI 0.78–0.80; P < 0.0001; I² = 0%) and pooled estimates for TTP and infertility risk were non-significant but directionally consistent, indicating a 29% longer TTP (TR 1.29, 95% CI 0.84–1.97; I² = 88%) and a 17% higher infertility risk (RR 1.17, 95% CI 0.94–1.47; I² = 34%), though these findings should be interpreted with caution given the heterogeneity and limited evidence.Discussion: Plausible biological mechanisms underlying the association involve chronic inflammation and endothelial dysfunction, which may impair endometrial receptivity, implantation, and early embryo development. Further studies incorporating objective male reproductive measures are required.Conclusion: Preconception hypertension may be associated with lower fecundability. In the interim, blood pressure optimization and fertility assessment before pregnancy are recommended.Hubungan antara Hipertensi Prakonsepsi pada Perempuan dan Fekundabilitas: Tinjauan Sistematis dan Meta-AnalisisAbstrakTujuan: Studi ini bertujuan mengevaluasi hubungan antara hipertensi prakonsepsi dan fekundabilitas pada wanita.Metode: Penelitian ini menggunakan metode tinjauan sistematis dan meta-analisis yang dipandu oleh PRISMA serta terdaftar di PROSPERO (CRD420261281401). Pencarian dilakukan pada beberapa basis data dan penelusuran referensi secara manual. Luaran meliputi fekundabilitas, waktu hingga kehamilan (TTP), dan infertilitas (TTP>12 bulan). Estimasi efek digabungkan dan dilaporkan sebagai rasio peluang fekundabilitas (FOR), rasio waktu (TR), dan rasio risiko (RR) dengan interval kepercayaan 95%.Hasil: Hipertensi prakonsepsi dikaitkan dengan potensi penurunan fekundabilitas sebesar 21% (FOR 0,79, 95% CI 0,78–0,80; P < 0,0001; I² = 0%). Estimasi gabungan TTP dan risiko infertilitas tidak signifikan secara statistik tetapi menunjukkan arah yang konsisten, yaitu TTP 29% lebih lama (TR 1,29, 95% CI 0,84–1,97; I² = 88%) dan risiko infertilitas 17% lebih tinggi (RR 1,17, 95% CI 0,94–1,47; I² = 34%). Meskipun demikian, temuan ini perlu diinterpretasikan secara hati-hati mengingat adanya heterogenitas dan keterbatasan bukti.Diskusi: Mekanisme biologis yang mungkin mendasari hubungan ini melibatkan peradangan kronis dan disfungsi endotel yang dapat mengganggu reseptivitas endometrium, implantasi, dan perkembangan embrio dini. Diperlukan studi lebih lanjut yang memasukkan pengukuran reproduksi pria yang objektif.Kesimpulan: Hipertensi prakonsepsi mungkin dikaitkan dengan fekundabilitas yang lebih rendah. Sementara itu, optimalisasi tekanan darah dan penilaian kesuburan sebelum kehamilan direkomendasikan.