Association of Assisted Reproductive Technology with the Risk of Congenital Heart Defects: A 5-Year Retrospective Study – Experience from a Tertiary Maternity Hospital in Bucharest

Author(s): Ioana Ro?ca, Alina Turenschi, Alexandra Raris-Denisa, Daniela-Eugenia Popescu, Cristina Stoica, Andreea Carp-Veliscu, Ana-Maria-Cristina Jura, Andreea Teodora Constantin

Congenital heart disease (CHD) represents a group of abnormalities present at birth, and a relevant cause of perinatal mortality. Infertility is a recurrent condition in medical practice, affecting almost 7% of couples. Causes are multiple and complex, including genetic and environmental factors [1]. Assisted Reproductive Technology (ART) treatment for infertility uses in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and oocyte donation (OD). Studies assessing the CHD risk in IVF/ ICSI pregnancies, showed a higher probability as opposed to spontaneous conceptions [2]. The study’s aim was to evaluate CHD prevalence in ART pregnancies over 5 years (January 2016-December 2020) and highlight the need of cardiac screening. We conducted a cross-sectional study at the Clinical Hospital of Obstetrics and Gynecology "Prof. Dr. Panait Sârbu", with a compartment dedicated to infertility. 349 ART newborns and 18,170 spontaneous conceptions were included in the analysis. The prevalence of congenital heart malformations in ART pregnancies was 3,15% and in spontaneous pregnancies only 0,51% (p<0,001). The most common CHDs were ventricular septal defect and coarctation of the aorta. We reported 11 cases, but the most challenging was an extremely preterm infant with patent ductus arteriosus (PDA), unresponsive to pharmacological therapy, requiring surgical ligation. PDA is frequent in preterms, and required for survival in some CHDs. Our paper shows that neonates conceived through ART have an increased risk of developing CHD compared to spontaneous conceptions. If CHD suspicion occurs, monitoring must happen in a unit capable of managing high-risk cases such as intrauterine growth restriction (IUGR) or prematurity.