Are Offspring of IVF/ICSI Pregnancies at Higher Risk for Congenital Heart Defects?

BACKGROUND AND PURPOSE: 

  • There have been studies that suggest an increased risk for cardiac defects in IVF/ICSI pregnancies
  • There are no meta-analyses that specifically look at the incidence of CHD in the IVF/ICSI  
  • Giorgione et al. (Ultrasound in Obstetrics & Gynecology, 2018) examined whether there was a higher risk of congenital heart defects (CHD) in offspring conceived through IVF/ICSI 

METHODS: 

  • Systematic review and meta-analysis 
  • Literature search of studies comparing neonatal incidence of CHD in pregnancies conceived after IVF/ICSI and those conceived spontaneously  
  • For the meta-analysis, the authors selected cohort studies to estimate the pooled odds ratio (OR) with 95% CI   

RESULTS: 

  • Data was pooled from 8 cohort studies for meta-analysis 
    • 25,856 children were conceived using IVF/ICSI techniques and 287,995 children conceived spontaneously  
    • Both singleton and multiple gestations were included  
  • 1.30% of patients in the IVF/ICSI group and 0.68% in the spontaneous conception group had CHD events  
  • The risk of CHD was significantly increased in the IVF/ICSI group  
    • Pooled OR, 1.45; 95% CI, 1.20–1.76 (P = 0.0001)  
  • In the subgroup of singleton pregnancies, a significant difference was also evident 
    • Pooled OR, 1.29; 95% CI, 1.03–1.60; P = 0.02 
  • CHD subtypes
    • VSD was more frequent in IVF/ICSI
    • TOF (tetralogy of Fallot) and TGA (transposition of great arteries) were more common in pregnancies conceived spontaneously

CONCLUSION: 

  • The risk of CHD in IVF/ICSI pregnancies is significantly increased by approximately 50% 
  • CHD subtypes
    • VSD was more frequent in IVF/ICSI
    • TOF and TGA were more common in pregnancies conceived spontaneously  
  • These results held in subgroup analyses even after adjusting for confounding factors, including maternal age  
  • The authors cite results of this paper as evidence to support fetal echocardiography in IVF/ICSI pregnancies 

Learn More – Primary Sources:

Congenital heart defects in IVF/ICSI pregnancy: systematic review and meta-analysis 

 

Does ART increase the risk for imprinting disorders such as BWS?

BACKGROUND AND PURPOSE:

  • There have been reports of an association between assisted reproductive techniques (ART) and imprinting disorders, for example (clinical findings and management for syndromes can be found in ‘Learn More – Primary Sources below)
    • Beckwith-Wiedemann syndrome (BWS)
    • Russell-Silver syndrome
    • Angelman syndrome
  • Mussa et al. (Pediatrics, 2017) examined the prevalence of Beckwith-Wiedemann syndrome (BWS) in children born through ART to further refine relative risk

METHODS:

  • BWS patients were identified and matched with general demographic data and corresponding regional ART registry
  • BWS criteria included at least 2 of the following
    • Abdominal wall defect, macroglossia, macrosomia, embryonal tumor, ear malformations, organ enlargement, nevus flammeus, hemihyperplasia, nephron/urological malformations, hypoglycemia, or family history of BWS

RESULTS:

  • Out of a total population of 379,872 live births, 7884 ART live births were studied
  • Within the total population, there were 38 patients with BWS (7 from ART and 31 naturally)
  • BWS birth prevalence was significantly higher in the ART group
  • In the ART group the relative risk was higher in BWS compared to non-ART at 10.7 (887.9 per 1,000,000 vs 83.3 per 1,000,000 risk)

CONCLUSION:

  • There is an approximately ten-fold increased risk of BWS in ART children

Learn More – Primary Sources:

Assisted Reproductive Techniques and Risk of Beckwith-Wiedemann Syndrome

GeneReviews: Beckwith-Wiedemann Syndrome

GeneReviews: RussellSilver Syndrome

GeneReviews: Angelman Syndrome