A new Australian study has uncovered a potential link between assisted reproductive technology (ART) pregnancies and a higher risk of birth defects compared to naturally conceived pregnancies. The research found that in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) pregnancies were more likely to be exposed to teratogenic medications during the first trimester, which may increase the risk of fetal harm.
Study Overview
Researchers from the University of South Australia (UniSA), The University of Western Australia (UWA), and The Kids Research Institute analyzed over 57,000 pregnancies over a two-year period. The study focused on four conception groups: women using ART (2,041 pregnancies), those taking medication to induce ovulation (590 pregnancies), untreated sub-fertile women (2,063 pregnancies), and naturally fertile women (52,987 pregnancies).
The findings revealed that ART pregnancies had the highest exposure to Category D medications, drugs that may be harmful to the fetus but are used for specific clinical benefits, such as the management of mental health disorders or epilepsy. These medications are classified by Australia’s Therapeutic Goods Administration (TGA) as posing a potential risk to the fetus during pregnancy. Category X drugs, which carry a higher risk of harm and are strongly discouraged during pregnancy, were found to have minimal exposure across all groups.
Key Findings
The study showed that 4.9% of ART pregnancies were exposed to Category D medications during the first trimester, compared to just 0.6% in naturally conceived pregnancies. This higher exposure persisted into the later trimesters, with 3.4% of ART pregnancies exposed to Category D medications compared to 0.6% of naturally conceived pregnancies.
While the exposure to Category X medications was low in all groups (less than 0.5% across all trimesters), the higher incidence of Category D medication use in ART pregnancies may contribute to the increased risk of birth defects observed in ART babies.
Dr. Anna Kemp-Casey, the lead author of the study, explained that the differences in exposure were mainly due to medications used to prevent repeat miscarriages or failed implantation, rather than treatments for chronic conditions.
The most frequently used Category D/X medications across all pregnancies included paroxetine (an antidepressant), lamotrigine (used for epilepsy), valproic acid (used for seizure management), carbamazepine (another epilepsy treatment), and nicotine dependence treatments.
Impact on ART Pregnancies
Professor Roger Hart, co-researcher from UWA and national medical director of City Fertility, noted that while ART pregnancies are generally planned and closely monitored, the medications used during fertility treatments may inadvertently increase the risk of birth defects, particularly during critical periods of fetal development.
“The higher exposure to Category D and X medications in ART pregnancies during the first trimester may contribute to the higher rate of birth defects observed in ART babies,” said Professor Hart. However, he emphasized that the majority of IVF babies are healthy, and these findings do not suggest that ART pregnancies are unsafe.
Conclusion and Future Research
The study underscores the importance of personalized medical care for women undergoing ART treatments, highlighting the need for close monitoring during early pregnancy. Researchers believe more studies are required to further investigate the impact of Category D and X medication exposure on pregnancy outcomes and to better understand the role of maternal medical conditions in the increased risk of birth defects in ART pregnancies.
The study’s findings contribute to a growing body of evidence regarding the complexities of ART pregnancies and the importance of carefully managing medication use during fertility treatments.
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