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Congenital heart defects in IVF/ICSI pregnancy: systematic review and meta-analysis
- Source :
- Ultrasound in obstetricsgynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 51(1)
- Publication Year :
- 2017
-
Abstract
- Objective: There is no consensus in current practice guidelines on whether conception by in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) techniques is an indication for performing a fetal echocardiogram. The aim of the study was to assess whether congenital heart defects (CHD) occur more often in pregnancies conceived after IVF/ICSI as compared with those conceived spontaneously. Methods: A systematic search for studies was conducted of PubMed/MEDLINE, EMBASE and Scopus from inception to September 2017. The search included the following medical subject heading (MeSH) terms alone or in different combinations: âIVFâ, âIVF/ICSIâ, âART pregnancyâ, âassisted conceptionâ, âbirth defectâ, âcongenital heart defectsâ and âcongenital malformation or abnormalitiesâ. Studies comparing neonatal incidence of CHD in pregnancies conceived after IVF/ICSI and those conceived spontaneously were included. Studies reporting on other types of assisted reproductive technology (ART) or lacking information concerning termination of pregnancy were excluded. Chromosomal abnormalities were excluded in all analyzed studies. A meta-analysis of selected cohort studies was conducted to estimate the pooled odds ratio (OR) with 95% CI using a random-effects model. Statistical heterogeneity among the studies was evaluated with the I2 statistic and Q-test. Results: Forty-one studies were identified for review including six caseâcontrol and 35 cohort studies. Data of eight selected cohort studies were used for meta-analysis. A total of 25 856 children conceived from IVF/ICSI techniques and 287 995 children conceived spontaneously, involving both singleton and multiple gestations, were included in the analysis. Total CHD events were 337/25 856 (1.30%) and 1952/287 995 (0.68%) in the IVF/ICSI and spontaneous conception groups, respectively. The risk of CHD was significantly increased in the IVF/ICSI group as compared with the spontaneous conception group (pooled OR, 1.45; 95% CI, 1.20â1.76; P = 0.0001; I2 = 44%; P = 0.08). In the subgroup of singleton IVF pregnancies, a significant difference was also obtained (OR, 1.55; 95% CI, 1.21â1.99; P = 0.0005; I2 = 36%; P = 0.18) and also multiple confounding factors adjusted ORs showed statistical significance (pooled OR, 1.29; 95% CI, 1.03â1.60; P = 0.02; I2 = 0%; P = 0.43). Conclusion: Fetuses conceived with IVF/ICSI methods are at an increased risk of developing CHD compared with those conceived spontaneously. However, this finding deserves further investigation due to heterogeneity of both ART procedures and cardiac defects. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
- Subjects :
- Radiology, Nuclear Medicine and Imaging
medicine.medical_treatment
030204 cardiovascular system & hematology
fetal echocardiography
Intracytoplasmic sperm injection
Infant, Newborn, Diseases
0302 clinical medicine
Pregnancy
Risk Factors
Medicine
030212 general & internal medicine
reproductive and urinary physiology
030219 obstetrics & reproductive medicine
Radiological and Ultrasound Technology
Obstetrics
Incidence
Obstetrics and Gynecology
General Medicine
congenital anomalie
IVF
Meta-analysis
embryonic structures
Gestation
Female
ART
Cohort study
Heart Defects, Congenital
medicine.medical_specialty
Reproductive Techniques, Assisted
ICSI
congenital heart defect
03 medical and health sciences
Spontaneous conception
Humans
Radiology, Nuclear Medicine and imaging
Perinatal Mortality
assisted conception
Assisted reproductive technology
urogenital system
business.industry
Case-control study
Infant, Newborn
Odds ratio
medicine.disease
CHD
Reproductive Medicine
Case-Control Studies
Fertilization
business
Subjects
Details
- ISSN :
- 14690705
- Volume :
- 51
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Ultrasound in obstetricsgynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
- Accession number :
- edsair.doi.dedup.....a82b286d5d3c02a21d576b1feff476e7