Inserm, UMR S953, Recherche épidémiologique sur la santé périnatale et la santé des femmes et des enfants, Maternité Port-Royal, 6ème étage, 53, avenue de l'Observatoire, Paris 75014, France.
Hum Reprod. 2013 Feb;28(2):367-74. doi: 10.1093/humrep/des400. Epub 2012 Nov 22.
Are the risks of hypoplastic left heart syndrome, transposition of great arteries, tetralogy of Fallot (TOF) and coarctation of the aorta increased in infants conceived by different assisted reproductive techniques (ARTs)?
ARTs, and particularly intracytoplasmic sperm injection (ICSI), are specifically associated with a higher risk of TOF.
ARTs are associated with an increase in the overall risk of birth defects. The risk for congenital heart defects (CHDs) associated with ARTs has been evaluated as a whole but there is limited information on the risks for specific CHDs. STUDY DESIGN, MATERIAL AND METHODS: We conducted a case-control study using population-based data from the Paris registry of congenital malformations for the period 1987-2009 and a cohort study of CHD (EPICARD) on 1583 cases of CHDs and 4104 malformed controls with no known associations with ARTs. ARTs included ovulation induction only, IVF and ICSI.
Exposure to ARTs was significantly higher for TOF than controls (6.6 versus 3.5%, P = 0.002); this was not the case for the other three CHDs. ARTs (all methods combined) were associated with a 2.4-fold higher odds of TOF after adjustment for maternal characteristics, paternal age and year of birth [adjusted odds ratios (OR): 2.4, 95% confidence interval (CI): 1.5-3.7] with the highest risk associated with ICSI (adjusted OR: 3.0, 95% CI: 1.0-8.9). No statistically significant associations were found for the other CHDs.
Our study cannot disentangle to what extent the observed associations between the risk of TOF and ARTs are due to causal effects of ARTs and/or the underlying infertility problems of couples who conceive following ART.
The developmental basis of the specific association between the risk of TOF and ARTs need to be further investigated.
不同辅助生殖技术（ART）受孕的婴儿患左心发育不全综合征、大动脉转位、法洛四联症（TOF）和主动脉缩窄的风险是否增加？
ART，特别是卵胞浆内单精子注射（ICSI），与 TOF 风险增加特别相关。
ART 与出生缺陷风险整体增加相关。ART 相关先天性心脏病（CHD）风险已作为一个整体进行了评估，但关于特定 CHD 风险的信息有限。
研究设计、材料和方法：我们使用了 1987 年至 2009 年巴黎出生缺陷登记处的基于人群的数据进行了病例对照研究，并对 1583 例 CHD 患者（EPICARD）和 4104 例无已知与 ARTs 相关畸形对照进行了 CHD 队列研究。ART 包括仅诱导排卵、体外受精和 ICSI。
暴露于 ARTs 的 TOF 患者明显高于对照组（6.6%比 3.5%，P=0.002）；而对于其他三种 CHD 则不然。调整母体特征、父亲年龄和出生年份后，ART（所有方法组合）与 TOF 的发生风险增加 2.4 倍相关（调整后的比值比（OR）：2.4，95%置信区间（CI）：1.5-3.7），与 ICSI 相关的风险最高（调整后的 OR：3.0，95%CI：1.0-8.9）。对于其他 CHD，未发现统计学上显著的相关性。
我们的研究无法区分观察到的 TOF 风险与 ARTs 之间的关联在多大程度上归因于 ARTs 的因果效应，以及接受 ARTs 受孕的夫妇的潜在不孕问题。
需要进一步研究 TOF 风险与 ARTs 之间的特定关联的发育基础。
