Newborns conceived through in vitro fertilization or intracytoplasmic sperm injection have a 45% higher risk for congenital heart defects, compared with those conceived spontaneously, according to findings published in Ultrasound in Obstetrics and Gynecology.
“Chromosomal anomalies ... and genetic mutations are responsible for less than 15% of [congenital heart defects (CHD)] and, in most cases, the etiology of CHD remains unknown. Hence it is critical to assess potential new risk factors in order to improve detection rate and possibly the outcome,” Veronica Giorgione, MD, from the department of obstetrics and gynecology at IRCCS San Raffaele Hospital in Italy, and colleagues wrote. “There is no consensus in current practice guidelines whether [in vitro fertilization (IVF)]/[intracytoplasmic sperm injection (ICSI)] conception represents an indication for performing a fetal echocardiogram according to different eminent scientific societies.”
Researchers evaluated whether CHD occurs more often with the use of IVF/ICSI techniques than with spontaneous pregnancies. Using multiple clinical databases, they conducted a systematic search for studies with the search terms IVF, IVF/ICSI, assisted reproductive technology pregnancy, assisted conception, birth defect, congenital heart defects and congenital malformation or abnormalities. They also included studies that compared neonatal incidence of CHD in IVF/ICSI and spontaneous conceptions.
Researchers identified 41 studies for review and used data from eight selected cohort studies in their meta-analysis. Of 25,856 children conceived from IVF/ICSI techniques and 287,995 children spontaneously conceived in singleton and multiple pregnancies, total CHD events were 337 (1.3%) and 1,952 (0.68%), respectively. In the IVF/ICSI group, the risk for CHD was significantly higher than in the spontaneous conception group (pooled OR = 1.45; 95% CI, 1.2-1.76; P = .0001). The same significant difference was seen in the singleton IVF pregnancies subgroup (OR = 1.55; 95% CI, 1.21-1.99; P = .0005), which persisted after adjusting for multiple confounders [OR = 1.29; 95% CI, 1.03-1.6; P = .02).
“The study shows an increased risk of CHD in IVF/ICSI pregnancies as compared to spontaneous conceptions, by about 50%,” Giogione and colleagues wrote. “We recommend fetal echocardiography in all pregnancies from IVF/ICSI in accordance with recent [American Heart Association] practice guidelines with prompt referral to specialist care in selected cases. This method will improve prenatal diagnosis, management and referral of the affected pregnancies for delivery and prenatal/postnatal interventions, with potential improvement of outcome.” – by Savannah Demko
Disclosure: The authors report no relevant financial disclosures.