Congenital malformations associated with assisted reproductive technology: A California statewide analysis,☆☆

https://doi.org/10.1016/j.jpedsurg.2013.03.017Get rights and content

Abstract

Background

Management of congenital malformations comprises a large part of pediatric surgical care. Despite increasing utilization of assisted reproductive technology (ART) and fertility-related services (FRS), associations with birth defects are poorly understood.

Methods

Infants born after ART or FRS were identified from the California Linked Birth Cohort Dataset from 2006 to 2007 and compared to propensity matched infants conceived naturally. Factors associated with major congenital malformations were evaluated using Firth logistic regression.

Results

With a cohort of 4,795 infants born after ART and 46,025 naturally conceived matched controls, major congenital malformations were identified in 3,463 infants. Malformations were increased for ART infants (9.0% vs. 6.6%, p < 0.001). After adjusting for infant and maternal factors, ART infants exhibited increased odds of major malformations overall (OR 1.25, 95% CI 1.12–1.39), specifically defects of the eye (OR 1.81, 95% CI 1.04–3.16), head and neck (OR 1.37, 95% CI 1.00–1.86), heart (OR 1.41, 95% CI 1.22–1.64), and genitourinary system (OR 1.40, 95% CI 1.09–1.82). The likelihood of birth defects was increased for multiples (OR 1.35, 95% CI 1.18–1.54) and not singletons. Odds of congenital malformation after FRS alone (n = 1,749) were non-significant.

Conclusion

ART contributes a significant risk of congenital malformation and may be more pronounced for multiples. Accurate counseling for parents considering ART and multidisciplinary coordination of care prior to delivery are warranted.

Section snippets

Data source

This retrospective cohort study was performed after obtaining IRB approvals from the University of California, Los Angeles and the California Office of Statewide Health Planning and Development (OSHPD). Data were obtained from the California Patient Discharge Linked Birth Cohort Database [11]. OSHPD collects annual data of all infants and mothers discharged from non-federal hospitals licensed in California. A discharge abstract is reported for each inpatient hospitalization and includes:

Results

Overall, a total of 1,749 infants born after FRS and 4,795 infants born after ART were identified and matched to 17,476 and 46,025 naturally conceived controls respectively (Table 1). Maternal age, race, parity and plurality did not significantly differ between infants born after FRS and matched controls. Infants born after ART had slightly older mothers and were more likely to be a multiple when compared to matched controls.

Infants born after FRS were slightly younger, more likely to be

Discussion

The pediatric surgeon and other pediatric healthcare providers are often consulted when a congenital malformation is diagnosed prenatally and/or postnatally. Understanding the components of the mother’s prenatal history, including use of fertility assistive services, is important in order to properly counsel parents regarding their child's prospective risk profile, factors complicating the delivery, and anticipated needs for specialized neonatal medical and surgical care. This study focuses on

Acknowledgments

The authors would like to sincerely thank Kara Calkins, M.D. from the UCLA Division of Neonatology for her insight and recommendations for the manuscript preparation.

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    Funding/Support: Dr. Kelley-Quon is supported by the Robert Wood Johnson Foundation. Dr. Stephen Shew is supported in part by NIH grant HD052885.

    ☆☆

    Role of the Sponsor: The Robert Wood Johnson Foundation had no role in the preparation, review, or approval of the manuscript.

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