A groundbreaking study from Australia has highlighted a potential link between assisted reproductive technology (ART) pregnancies and an increased risk of birth defects, revealing higher exposure to teratogenic medications compared to naturally conceived pregnancies. Published in the Australian and New Zealand Journal of Obstetrics and Gynaecology, the research examines the effects of certain medications during the first trimester of pregnancy, particularly in in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) pregnancies.
The study identifies that IVF and ICSI pregnancies have the highest exposure to Category D and X medicines—substances that can potentially harm the fetus. These medications, regulated by Australia’s Therapeutic Goods Administration (TGA), are known for their teratogenic risks. Category D drugs may carry risks, but are sometimes used for managing specific conditions, such as mental health disorders or epilepsy, where the benefits outweigh the potential harm. In contrast, Category X medications are strictly contraindicated due to their significant risks to fetal development.
A team of researchers from the University of South Australia (UniSA), The University of Western Australia (UWA), and The Kids Research Institute analyzed over 57,000 pregnancies across four groups over a two-year period. The groups included women undergoing ART (2,041 participants), those using ovulation-inducing medication (590), untreated sub-fertile women (2,063), and naturally fertile women (52,987). The study revealed that ART pregnancies were the most frequently exposed to Category D medications in the first trimester—4.9% of ART pregnancies, compared to only 0.6% in naturally conceived pregnancies.
This disparity continued in later trimesters, with 3.4% of ART pregnancies exposed to Category D medications, versus 0.6% in naturally conceived pregnancies. However, the study found that exposure to Category X medications, which are more harmful, was low across all groups, at under 0.5% in each trimester.
Dr. Anna Kemp-Casey, a UniSA researcher and the study’s lead, explained that the higher exposure to these medications is mainly due to additional treatments used after ART procedures to prevent miscarriage or implantation failure. For example, progestogens like medroxyprogesterone acetate were more commonly used in ART pregnancies during the study period, which could have been prescribed to treat recurrent miscarriages.
The study also identified the five most frequently used Category D/X medications across all pregnancy groups: paroxetine, lamotrigine, valproic acid, carbamazepine, and nicotine dependence treatments.
Professor Roger Hart, co-researcher at UWA and IVF clinician at City Fertility, noted that the increased exposure to these medications during ART pregnancies could contribute to the higher incidence of birth defects observed in ART children. Although ART pregnancies are often carefully planned, medications taken during fertility treatments may inadvertently expose the fetus to risks during critical stages of development.
Despite these findings, the researchers stress that the vast majority of babies conceived via ART are healthy. They emphasize that the study does not imply ART pregnancies are inherently unsafe but underscores the need for personalized medical care and vigilant monitoring for women undergoing ART treatment, particularly during early pregnancy. Prof. Hart advocates for further research to investigate the role of maternal medical conditions and the impact of Category D and X medication exposure in ART pregnancies, which could further inform treatment strategies and risk mitigation.
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