目标:在不孕症治疗后的活产中,紫红色先天性心脏病(CCHD)的风险是否升高?
结论:在这项基于人群的单胎研究中,不孕症治疗(ART或非ART)与活产中CCHD患病率较高相关.
背景:在过去的几十年中,不孕症治疗的使用一直在增加。然而,评估不孕症治疗后严重心脏缺陷风险的研究有限.
方法:对来自国家生命统计系统(NVSS)的分娩数据进行了回顾性队列研究,从2016年到2022年,年龄在15-49岁之间的首次母亲中有960万单胎出生。
方法:从出生证明的健康和医疗信息部分获得有关不孕症治疗使用和CCHD的信息,这是医护人员在审查医疗记录后完成的。使用Logistic回归模型估计比值比(OR)和95%CI。还进行了熵平衡加权分析和概率偏差分析。
结果:在研究期间,不孕症治疗后的分娩比例从1.9%(27.116)增加到3.1%(43.510)。总的来说,有5287例CCHD,导致每1000例活产中有0.6例的患病率.不孕症治疗使用者的患病率为每1000活产1.2例(ART:每1000活产1.1例;非ART:每1000活产1.3例),而自然受孕分娩的患病率为每1000活产0.5例。与自然分娩相比,使用任何不孕症治疗(OR:2.06,95%CI:1.82-2.33),ART(OR:2.02,95%CI:1.73-2.36)或其他不孕症治疗(OR:2.12,95%CI:1.74-2.33),在调整母亲和父亲年龄后,与更高的CCHD几率相关,种族和民族,和教育,以及母亲的出生,婚姻状况,付款来源,吸烟状况,和孕前BMI的测量,高血压和糖尿病。这种关联因不孕症治疗的类型(ART与其他不孕症治疗)而没有差异(OR:1.04,95%CI:0.82-1.33,P=0.712),并且对暴露和结果错误分类偏差和残余混杂的存在是稳健的。
结论:研究结果仅局限于活体分娩。我们没有能力检查终止数据,但是,通过概念模式的差分终止并没有得到先前旨在考虑它的研究的支持。不孕症治疗的使用是自我报告的,导致不孕症治疗和CCHD的选择偏倚和错误分类的可能性。然而,当分析中考虑了系统性偏倚以及暴露和结局错误分类偏倚时,这种关联仍然存在.关于与任一母体有关的不孕症的潜在病因的信息,父系,或者这两个因素,关于特定类型的ART和其他不孕症治疗的数据,以及CCHD亚型的信息,都不可用。
结论:鉴于在美国使用不孕症治疗的增加趋势,在其他地方,本研究的发现对生育年龄个体的临床和公共卫生具有重要意义.数据显示,使用不孕症治疗可能会使后代遭受严重的先天性心脏缺陷的可能性增加,例如此处研究的CCHD。这些发现不能因果关系解释。虽然我们的研究结果可以帮助通过ART或其他不孕症治疗怀孕的孕前咨询和产前护理,他们还支持目前的一些建议,即不孕症治疗导致的妊娠要接受胎儿超声心动图筛查.
背景:没有为这项研究寻求资助。作者声明他们没有利益冲突。
背景:不适用。
OBJECTIVE: Is there an elevated risk of cyanotic congenital heart defects (CCHD) among livebirths following infertility treatments?
CONCLUSIONS: In this population-based study of single livebirths, infertility treatment (either ART or non-ART) was associated with a higher prevalence of CCHD among livebirths.
BACKGROUND: The use of infertility treatment has been on the rise over the past few decades. However, there are limited studies assessing the risk of major cardiac defects following infertility treatments.
METHODS: A retrospective cohort study of livebirth data from the National Vital Statistics System (NVSS) was conducted, comprising of 9.6 million singleton livebirths among first-time mothers aged 15-49 years from 2016 to 2022.
METHODS: Information on infertility treatment use and CCHD was obtained from the health and medical information section of birth certificates, which was completed by healthcare staff after reviewing medical records. Logistic regression models were used to estimate odds ratios (OR) and 95% CI. Entropy balancing weighting analysis and probabilistic bias analysis were also performed.
RESULTS: The proportion of births following infertility treatment increased from 1.9% (27 116) to 3.1% (43 510) during the study period. Overall, there were 5287 cases of CCHD resulting in a prevalence of 0.6 per 1000 livebirths. The prevalence was 1.2 per 1000 live births among infertility treatment users (ART: 1.1 per 1000 livebirths; non-ART: 1.3 per 1000 livebirths) while that for naturally conceived births was 0.5 per 1000 livebirths. Compared to naturally conceived births, the use of any infertility treatment (OR: 2.06, 95% CI: 1.82-2.33), either ART (OR: 2.02, 95% CI: 1.73-2.36) or other infertility treatments (OR: 2.12, 95% CI: 1.74-2.33), was associated with higher odds of CCHD after adjusting for maternal and paternal age, race and ethnicity, and education, as well as maternal nativity, marital status, source of payment, smoking status, and pre-pregnancy measures of BMI, hypertension and diabetes. This association did not differ by the type of infertility treatment (ART versus other infertility treatments) (OR: 1.04, 95% CI: 0.82-1.33, P = 0.712), and was robust to the presence of exposure and outcome misclassification bias and residual confounding.
CONCLUSIONS: The findings are only limited to livebirths. We did not have the capacity to examine termination data, but differential termination by mode of conception has not been supported by previous studies designed to consider it. Infertility treatment use was self-reported, leading to the potential for selection bias and misclassification for infertility treatment and CCHD. However, the association persisted when systematic bias as well as exposure and outcome misclassification bias were accounted for in the analyses. Information on the underlying etiology of infertility relating to either maternal, paternal, or both factors, data on specific types of ART and other infertility treatments, as well as information on subtypes of CCHD, were all not available.
CONCLUSIONS: In light of the increasing trend in the use of infertility treatment in the USA, and elsewhere, the finding of the current study holds significant importance for the clinical and public health of reproductive-aged individuals. The data show that the use of infertility treatment may expose offspring to elevated odds of severe congenital heart defects such as CCHD studied here. These findings cannot be interpreted causally. While our findings can assist in preconception counseling and prenatal care for pregnancies conceived by either ART or other infertility treatments, they also support some current recommendations that pregnancies resulting from infertility treatments undergo fetal echocardiography screening.
BACKGROUND: No funding was sought for the study. The authors declare that they have no conflict of interest.
BACKGROUND: N/A.