Department of Obstetrics and Gynecology, Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Giuseppe Massarenti, 13, 40138, Bologna, Italy.
Department of Women's and Children's Health Gynecologic and Obstetrics Clinic, University of Padua, Pauda, Italy.
Arch Gynecol Obstet. 2024 Oct;310(4):2073-2080. doi: 10.1007/s00404-024-07669-x. Epub 2024 Aug 1.
To investigate whether congenital heart diseases exhibit higher rates in pregnancies achieved through assisted reproductive technology (ART) compared to natural conception.
In this retrospective cohort study, multinomial logistic regression was employed to analyze the relationship between categories of congenital heart diseases and three conception groups (IVF, ICSI, and natural pregnancies). The main outcome measures are risks of congenital heart disease categories in IVF and ICSI groups using the natural group as reference. We selected fetuses referred for fetal echocardiography to IRCCS Policlinico Sant'Orsola, Bologna, between January 2005 and November 2023, diagnosed with congenital heart diseases.
We categorized the congenital heart diseases into six groups based on anatomical and embryological criteria. The estimated risk of left ventricular outflow tract, valvular, conotruncal, and atrioventricular septal defects was lower in the IVF group compared to natural conception. The estimated risk of valvular and atrioventricular septal defects was lower in the ICSI group vs natural. Conversely, the risk for right heart anomalies was higher both in the IVF and ICSI groups compared to natural conception. Heart rhythm diseases were more frequent in IVF pregnancies. When comparing ART methods, valvular defects, conotruncal defects, and right heart anomalies were more frequently observed in the ICSI group, while atrioventricular septal defects were more common in the IVF group.
Significant differences were found in the occurrence of congenital heart diseases in pregnancies conceived through IVF and ICSI, versus those conceived naturally, underscoring the importance of further studying the underlying mechanisms of these associations.
研究与自然受孕相比，辅助生殖技术（ART）受孕的妊娠是否更易发生先天性心脏病。
在这项回顾性队列研究中，我们采用多项逻辑回归分析了先天性心脏病的种类与三种受孕方式（体外受精、卵胞浆内单精子注射和自然受孕）之间的关系。主要观察指标为将自然受孕组作为参照，比较 IVF 和 ICSI 组中先天性心脏病各分类的发病风险。我们选择了 2005 年 1 月至 2023 年 11 月期间在意大利博洛尼亚圣奥尔索拉综合医院因胎儿心脏超声检查转诊的、诊断为先天性心脏病的胎儿。
我们根据解剖学和胚胎学标准将先天性心脏病分为六组。与自然受孕相比，IVF 组左心室流出道、瓣膜、圆锥动脉干和房室间隔缺损的发病风险较低。ICSI 组瓣膜和房室间隔缺损的发病风险低于自然受孕。相反，IVF 和 ICSI 组右心畸形的发病风险均高于自然受孕。IVF 妊娠的心律失常更为常见。在比较 ART 方法时，ICSI 组中瓣膜缺损、圆锥动脉干缺损和右心畸形更为常见，而 IVF 组中房室间隔缺损更为常见。
IVF 和 ICSI 受孕与自然受孕的妊娠相比，先天性心脏病的发生存在显著差异，这突显了进一步研究这些关联的潜在机制的重要性。
