title: Congenital malformations associated with assisted reproductive technology: a California statewide analysis.
abstract: BACKGROUND
  Management of congenital malformations comprises a large part of pediatric surgical care. Despite increasing utilization of assisted reproductive technology (ART) and fertility-related services (FRS), associations with birth defects are poorly understood.
  
  
  METHODS
  Infants born after ART or FRS were identified from the California Linked Birth Cohort Dataset from 2006 to 2007 and compared to propensity matched infants conceived naturally. Factors associated with major congenital malformations were evaluated using Firth logistic regression.
  
  
  RESULTS
  With a cohort of 4,795 infants born after ART and 46,025 naturally conceived matched controls, major congenital malformations were identified in 3,463 infants. Malformations were increased for ART infants (9.0% vs. 6.6%, p<0.001). After adjusting for infant and maternal factors, ART infants exhibited increased odds of major malformations overall (OR 1.25, 95% CI 1.12-1.39), specifically defects of the eye (OR 1.81, 95% CI 1.04-3.16), head and neck (OR 1.37, 95% CI 1.00-1.86), heart (OR 1.41, 95% CI 1.22-1.64), and genitourinary system (OR 1.40, 95% CI 1.09-1.82). The likelihood of birth defects was increased for multiples (OR 1.35, 95% CI 1.18-1.54) and not singletons. Odds of congenital malformation after FRS alone (n=1,749) were non-significant.
  
  
  CONCLUSIONS
  ART contributes a significant risk of congenital malformation and may be more pronounced for multiples. Accurate counseling for parents considering ART and multidisciplinary coordination of care prior to delivery are warranted.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7098, USA.
authors.forename: Lorraine I
authors.initials: LI
authors.lastname: Kelley-Quon
authors.forename: Chi-Hong
authors.initials: CH
authors.lastname: Tseng
authors.forename: Carla
authors.initials: C
authors.lastname: Janzen
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Shew
mesh_terms: D002140:California; D016022:Case-Control Studies; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000209:etiology*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D016017:Odds Ratio; D057216:Propensity Score; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Assisted reproductive technology; Birth defects; Congenital malformation; Fertility-related services