Is the probability of prenatal diagnosis or termination of pregnancy different for fetuses with congenital anomalies conceived following assisted reproductive techniques? A population‐based evaluation of fetuses with congenital heart defects

Abstract

Objective To compare the probability of prenatal diagnosis (PND) and termination of pregnancy for fetal anomaly (TOPFA) between fetuses conceived by assisted reproductive techniques (ART) and spontaneously-conceived fetuses with congenital heart defects (CHD).Design Population-based observational study.Setting Paris and surrounding suburbs.Population Fetuses with CHD in the Paris registry of congenital malformations and cohort of children with CHD (Epicard).Methods Comparison of ART-conceived and spontaneously conceived fetuses taking into account potential confounders (maternal characteristics, multiplicity and year of birth or TOPFA).Main outcome measures Probability and gestational age at PND and TOPFA for ART-conceived versus spontaneously conceived fetuses.Results The probability of PND (28.1% versus 34.6%, P = 0.077) and TOPFA (36.2% versus 39.2%, P = 0.677) were not statistically different between ART-conceived (n = 171) and spontaneously conceived (n = 4620) fetuses. Estimates were similar after adjustment for potential confounders. Gestational age at PND tended to be earlier for ART fetuses (23.1 versus 24.8 weeks, P = 0.05) but no statistical difference was found after adjustment for confounders. Gestational age at TOPFA was comparable between ART-conceived and spontaneously conceived fetuses.Conclusions In our population, ART conception was not significantly associated with the probability of PND or TOPFA for CHD. One implication of our results is that live births may be adequate for assessing the overall risk of CHD related to ART. However, total prevalence, in particular of severe CHD, would not be adequately assessed if TOPFA are not included.Keywords Assisted, congenital, epidemiology/population-based, heart defects, prenatal diagnosis, reproductive techniques, termination of pregnancy for fetal anomaly.Please cite this paper as: Tararbit K, Lelong N, Jouannic J-M, Goffinet F, Khoshnood B on behalf of the EPICARD Study Group. Is the probability of prenatal diagnosis or termination of pregnancy different for fetuses with congenital anomalies conceived following assisted reproductive techniques? A population-based evaluation of fetuses with congenital heart defects. BJOG 2015;122:924-931. †

Perinatal and maternal outcome after vitrification of blastocysts: a Nordic study in singletons from the CoNARTaS group

“…Following infertility and an ART pregnancy, the inclination to terminate a pregnancy could be assumed to be lower if detecting a birth defect, which could influence the numbers and the analyses when comparing birth defects in ART and spontaneously conceived children. However, this has not been shown in studies from Finland and France, indicating similar rates on termination of pregnancies in ART and SC pregnancies (Pelkonen et al, 2014, Tararbit et al, 2015.…”

Trends over time in congenital malformations in live‐born children conceived after assisted reproductive technology

“…This was supported by a recent French study on congenital heart malformation after ART. They found that malformation data on live‐born children are most likely adequate when assessing the risk of malformations, as they did not find a difference in the rate of pregnancy terminations between ART and SC after identification of severe congenital heart malformations . A potential reporting bias for ART children seems unlikely, since only major malformations were included in this study and would therefore be expected to be detected regardless of mode of conception.…”

The health of children conceived by ART: ‘the chicken or the egg?’

“…has not received much attention in the literature. A single study on congenital heart defects in France showed no difference in either prenatal diagnosis or the termination of pregnancies between ART and non-ART births (Tararbit et al 2015).…”