title: Assisted reproductive technology and major structural birth defects in the United States.
abstract: BACKGROUND
  With >1% of US births occurring following use of assisted reproductive technology (ART), it is critical to examine whether ART is associated with birth defects.
  
  
  METHODS
  We analyzed data from the National Birth Defects Prevention Study, a population-based, multicenter, case-control study of birth defects. We included mothers of fetuses or live-born infants with a major birth defect (case infants) and mothers who had live-born infants who did not have a major birth defect (control infants), delivered during the period October 1997-December 2003. We compared mothers who reported ART use (IVF or ICSI) with those who had unassisted conceptions. Multiple logistic regression was used to adjust for the following confounders: maternal race/ethnicity, maternal age, smoking and parity; we stratified by plurality.
  
  
  RESULTS
  ART was reported by 1.1% of all control mothers, and by 4.5% of control mothers 35 years or older. Among singleton births, ART was associated with septal heart defects (adjusted odds ratio [aOR] = 2.1, 95% confidence intervals [CI] 1.1-4.0), cleft lip with or without cleft palate (aOR = 2.4, 95% CI 1.2-5.1), esophageal atresia (aOR = 4.5, 95% CI 1.9-10.5) and anorectal atresia (aOR = 3.7, 95% CI 1.5-9.1). Among multiple births, ART was not significantly associated with any of the birth defects studied.
  
  
  CONCLUSIONS
  These findings suggest that some birth defects occur more often among infants conceived with ART. Although the mechanism is not clear, couples considering ART should be informed of all potential risks and benefits.
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road N.E., MS E-86, Atlanta, GA 30033, USA. nzr5@cdc.gov
authors.forename: J
authors.initials: J
authors.lastname: Reefhuis
authors.forename: M A
authors.initials: MA
authors.lastname: Honein
authors.forename: L A
authors.initials: LA
authors.lastname: Schieve
authors.forename: A
authors.initials: A
authors.lastname: Correa
authors.forename: C A
authors.initials: CA
authors.lastname: Hobbs
authors.forename: S A
authors.initials: SA
authors.lastname: Rasmussen
mesh_terms: D016022:Case-Control Studies; D000013:Congenital Abnormalities / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology