Risk of birth defects increased in pregnancies conceived by assisted human reproduction
Received 28 February 2008; received in revised form 23 July 2008; accepted 7 August 2008. published online 29 October 2008.
Objective
To assess the risk of birth defects in infants born after assisted human reproduction (AHR).
Design
Retrospective cohort study.
Setting
Niday Perinatal Database for the province of Ontario, 82 sites, both primary and tertiary centers.
Patient(s)
In 2005, information about reproductive assistance was reported for 61,569 deliveries.
Intervention(s)
The prevalence of birth defects diagnosed in the prenatal period or at birth was estimated for all types of AHR together and then by type of procedure.
Main Outcome Measure(s)
The excess risks of birth defects by AHR were calculated by unconditional logistic regressions using spontaneously conceived pregnancies as the reference and were expressed by odds ratio and 95% confidence intervals and adjusted for maternal age, smoking, infant gender, gestation, and parity.
Result(s)
The prevalence of birth defects with AHR procedures was 2.91%, which was 1.55-fold higher (95% confidence interval [CI], 1.03–2.38) than in the non-AHR population (1.86%). Specific anomalies that increased with AHR were gastrointestinal (odds ratio [OR], 9.85; 95% CI, 3.44–28.44), cardiovascular (OR, 2.30; 95% CI, 1.11–4.77), and musculoskeletal defects (OR, 1.54; 95% CI, 0.48–4.94). The risks of birth defects by types of AHR were 2.35% for ovulation induction, 2.89% for IUI, and 3.45% for IVF.
Conclusion(s)
There is a significant increased risk of birth defects associated with AHR, and the risk is higher in IVF and IUI. The potential risk of anomalies associated with AHR may be considered in the counseling that is offered to infertile couples.
aDepartment of Obstetrics and Gynecology and Neonatal Care, Ottawa Health Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
bOMNI Research Group, Ottawa Health Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
cOntario Perinatal Surveillance System, Ottawa Health Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
dThe Ottawa Fertility Centre, Ottawa Health Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
Reprints requests: Dr. Mark Walker, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 241, Room 1818, Ottawa, ON K1H 8L6 (FAX: 613-739-6266).
D.E.-C. has nothing to disclose. Q.Y. has nothing to disclose. J.G. has nothing to disclose. J.B. has nothing to disclose. A.L. has nothing to disclose. S.W.W. has nothing to disclose. M.W. has nothing to disclose.
This project was presented at the Society of Maternal Fetal Medicine's 27th Annual Scientific Meeting, which was held in San Francisco on February 9, 2007.
This study was done in partnership with the Ontario Perinatal Surveillance System. Drs. Wen and Walker are recipients of a New Investigator's Award from CIHR.
This study was part of the Program on Oocyte Health, funded under the Healthy Gametes and Great Embryos Strategic Initiative of the Canadian Institutes of Health Research (CIHR) Institute of Human Development, Child and Youth Health (IHDCYH) (grant no: HGG62293).
ABSTRACT