64 Risk of Congenital Heart Defects for Children Conceived Following Assisted Reproductive Technologies. A Population Based Evaluation

Abstract

Background: Children conceived after ART have higher risks for adverse birth outcomes. Insufficient data exist regarding the specific risk for CHD. Objective: To estimate the risk associated with Assisted Reproductive Technologies (ART) for congenital heart defects (CHD), CHD without chromosomal abnormalities and CHD subgroups defined based on anatomo-embryologic criteria. Methods: We used data from the Paris Registry of Congenital Malformations on 5,599 cases of CHD and 3,985 malformed controls including a heterogeneous group of malformations for which no known associations with ART were reported in literature. ART included inductors of ovulation only, in vitro fertilization and intracytoplasmic sperm injection. Results: Exposure to ART (all methods combined) was higher for cases than controls (4.7% vs. 3.6%, p=0.008) and was associated with a 40% increase in the maternal age, socioeconomic factors and year of birth-adjusted odds of CHD without chromosomal abnormalities (Adjusted-OR 1.4, 95%CI 1.1-1.7). ART was specifically associated with significant increases in the odds of malformations of great vessels and outflow tracts (Adjusted-OR 1.7, 95%CI 1.2-2.4), of anomalies of atria and atrial septal defects (Adjusted-OR 1.8, 95%CI 1.1-2.8) and of conotruncal CHD and double outlet right ventricle (Adjusted-OR 1.7, 95%CI 1.1-2.7). In general, we found specific associations between methods of ART and subgroups of CHD. Conclusion: Risk of CHD was higher in children exposed to ART as compared to malformed controls. This association seems to vary according to the method of ART and type of CHD and may be due to ART per se and/or the underlying infertility of couples.