Assisted Reproduction · Safety and Risks

Congenital Malformations in Infants of Mothers Undergoing Assisted Reproductive Technologies: A Systematic Review and Meta-analysis Study

Hoorsan H, Mirmiran P, Chaichian S, Moradi Y, Hoorsan R, Jesmi F

Published November 2017 Journal of preventive medicine and public health = Yebang Uihakhoe chi
DOI 10.3961/jpmph.16.122 PMID 29207452 PMC PMC5717326

RRM Academy Synopsis

Infants conceived by ART had higher odds of congenital abnormalities

ART-conceived infants had 1.53 times the odds of congenital abnormalities compared with infants conceived spontaneously, a 2017 meta-analysis found. The 30 pooled cohort and case-control studies included 5 470 181 infants. The ART group also had higher odds of low birth weight and preterm labor. Chromosomal abnormalities showed no significant difference.

Key Findings

  • Overall congenital abnormalities: odds ratio 1.53 (95% CI, 1.37 to 1.70) for infants conceived by ART compared with spontaneously conceived infants.
  • Low birth weight: odds ratio 1.89 (95% CI, 1.36 to 2.62). Preterm labor: odds ratio 1.79 (95% CI, 1.21 to 2.63).
  • Cardiac abnormalities: odds ratio 1.43. Central nervous system abnormalities: odds ratio 1.36 (95% CI, 1.10 to 1.70).
  • Urogenital abnormalities: odds ratio 1.58 (95% CI, 1.28 to 1.94). Musculoskeletal abnormalities: odds ratio 1.35 (95% CI, 1.12 to 1.64).
  • Chromosomal abnormalities: odds ratio 1.14 (95% CI, 0.90 to 1.44), which the authors report as statistically nonsignificant.

Interpretation

The pooled studies were cohort and case-control designs, so the results show association. The authors note a notable discrepancy among studies, with heterogeneity (I2) of 89.7% for overall congenital abnormalities. They say it can be due to differences in how infants were assessed and in matching for maternal age, reason and duration of infertility, previous treatments, smoking and alcohol. Some researchers concluded that the added risk should be sought more in the couple's problems and the reason for infertility than in the treatment. The authors suggest that future studies draw controls from infertile couples who conceived spontaneously. Searches covered 2005 to 2015 and English-language full texts.

RRM Context

The authors suggest studying infertile couples who conceived spontaneously, which brings the cause of infertility into the risk question. Restorative reproductive medicine starts from that cause: it evaluates both partners to find why conception has not occurred and treats what it finds. ART bypasses the reproductive system without resolving why conception fails.

Abstract

This meta-analysis aimed to evaluate congenital malformations in infants conceived by assisted reproductive techniques (ART), compared with infants conceived spontaneously. In this study, available resources searched to find relevant articles included PubMed, ScienceDirect, Scopus, Google Scholar, Cochrane, ProQuest, Iranmedex, Magiran, and Scientific Information Database. After extracting the necessary information from evaluated articles, meta-analysis on the articles' data was performed using Stata version 11.2. In this study, from a total of 339 articles, extracted from the initial investigation, ultimately 30 articles were selected for meta-analysis that assessed the use of ART on the risk of congenital abnormalities and some birth complications on 5 470 181 infants (315 402 cases and 5 154 779 controls). The odds ratio (95% confidence interval [CI]) for low birth weight was 1.89 (95% CI, 1.36 to 2.62), preterm labor 1.79 (95% CI, 1.21 to 2.63), cardiac abnormalities 1.43 (95% CI, 1.27 to 1.62), central nervous system abnormalities 1.36 (95% CI, 1.10 to 1.70), urogenital system abnormalities 1.58 (95% CI, 1.28 to 1.94), musculoskeletal disorders 1.35 (95% CI, 1.12 to 1.64), and chromosomal abnormalities in infants conceived by ART was 1.14 (95% CI, 0.90 to 1.44), which were all statistically significant, except chromosomal abnormalities. The risk of congenital abnormalities and some birth complications were significantly higher in ART than normal conception, while chromosomal abnormalities were not; therefore, the application of ART should be selected individually for patients by detailed assessment to reduce such risks in the population.

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By this author

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Assisted Reproduction › Safety and Risks › Birth Defects · Pregnancy › Neonatal Outcomes › Neonatal Morbidity
Hayedeh Hoorsan, Parvin Mirmiran, Shahla Chaichian, Yousef Moradi, Roza Hoorsan, Fatemeh Jesmi
H Hoorsan, P Mirmiran, S Chaichian, Y Moradi, R Hoorsan, F Jesmi
PMID 29207452 29207452 DOI 10.3961/jpmph.16.122 10.3961/jpmph.16.122 Hoorsan et al. 2017, Hoorsan 2017