The effect of assisted reproductive technology on the incidence of birth defects among livebirths
Our study objective is to examine the association between births conceived with assisted reproductive technology (ART) and birth defects using a large database from the United States.
Using the Centers for Disease Control and Prevention’s Period-linked birth–infant death data files and fetal death database for 2011–2013, we conducted a retrospective cohort study comprised of live births that occurred in the USA during that time. Multivariate logistic regression was used to estimate the association between ART and birth defects, both overall and by specific defects.
There were 11,862,780 live births between 2011 and 2013. Of these births, 11,791,730 were spontaneous pregnancies and 71,050 were conceived by ART, with an increasing trend in incidence of ART during the study period and an overall increasing trend of birth defects. Overall, infants conceived by ART had a greater risk of having birth defects than did infants conceived spontaneously (77/10,000 vs 25/10,000, respectively, OR 2.14, 95% CI 1.94–2.35). The malformations most commonly associated with ART were cyanotic heart defects (OR 2.74, 95% CI 2.42–3.09), cleft lip and/or palate (OR 1.47, 95% CI 1.14–1.89), and hypospadias (OR 1.77, 95% CI 1.42–2.19). There were no differences in risk of omphalocele or neural tube defects between the two groups.
There is an overall and type-specific increased risk of birth defects in the ART population. Appropriate counseling and specialized ultrasound evaluations should be considered in pregnancies conceived by ART.
KeywordsAssisted reproductive technology Birth defects Morbidity Pregnancy
GSM: contributed to study design; interpretation of data; drafting of manuscript. NC-S: data management; data analysis; revision of manuscript. AS: contributed to study design; interpretation of data; critical revision of manuscript for important intellectual content. HAA: conception and design; acquisition of data; supervision; interpretation of data; critical revision of manuscript for important intellectual content.
Compliance with ethical standards
Conflict of interest
The authors report no conflict of interest. We had full control of all primary data and we agree to allow the Journal to review these data, if requested.
This study involved humans. These data files are available to the public; therefore, the institutional review board deemed this study to be exempt from ethics approval in accordance with the Tri-Council Policy statement (2010).
This study used exclusively publicly available data; hence, we did not personally obtain informed consent from study subjects. This would be the responsibility of the Agency for Healthcare Research and Quality (AHRQ), who sponsors the National Inpatient Sample.
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