ART, birth defects and subfertility—what should prospective patients be told?

Hansen, Michèle; Milne, Elizabeth; Klerk, Nicholas de; Kurinczuk, Jennifer J; Jacoby, Peter; Bower, Carol

doi:10.1007/s10815-011-9629-2

Cited by 6 publications

(4 citation statements)

References 12 publications

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“…It has been reported that the risk of having an infant with obstructive renal anomaly increased in overweight/obese and sub-fertile women (10). Therefore, application of assisted reproduction techniques due to subfertility was also evaluated in our study.…”

Section: Discussionmentioning

confidence: 99%

“…The fact that obesity and DM prevalence tend to increase globally has aroused suspicion that maternal overnutrition and its metabolic results may cause the formation of a similar negative environment for in utero kidney development (9). It was suggested that risk for having a child with obstructive renal anomaly increased in over-weight/ obese and sub-fertile women (10).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prenatal Risk Factors for Congenital Anomalies of the Kidney and Urinary Tract

Soylu¹,

Eroğlu²,

Türkmen³

et al. 2017

Turk Neph Dial Transpl

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OBJECTIVE: Congenital anomalies of the kidney and urinary tract (CAKUT) are the leading cause of chronic renal disease in childhood. Abnormal intrauterine conditions as well as genetic disorders play role in CAKUT development. We evaluated antenatal factors in CAKUT. MATERIAL and METHODS:The study and control groups included 140 CAKUT cases and 140 children without urinary malformation, respectively. Both groups were compared for antenatal (gestational period, prematurity, oligohydramios, preeclampsia, gestational diabetes, accompanying malformation, in vitro fertilization), maternal (age, body weight at pregnancy onset, weight gain during pregnancy, systemic disease, smoking, alcohol, medications) and familial (consanguinity, renal disease, urinary malformation) parameters. RESULTS:The study group had a shorter gestational period (38.8±2.9 vs. 39.5±0.9 week, p=0.004), but higher prematurity (9.3% vs. 0.7%, p=0.001), parity (≥2 parity 57.9% vs. 41.4%, p=0.006), oligohydramnios (6.4% vs. 0%, p=0.002), accompanying malformation (15.7% vs. 5.7%, p=0007), weight gain in pregnancy (18.8±2.9 vs. 18.1±2.8 kg, p=0.047) and familial renal disease (7.9% vs. 2.1%, p=0.028) rates. In vitro fertilization was present in only two cases in the study group. CONCLUSION:Weight gain in pregnancy and increased parity may be risk factors for CAKUT. Population-based studies are needed to determine the role of subfertility.KEy wORDS: CAKUT, Maternal weight, Parity, Risk factors, Subfertility Öz AMAÇ: Doğumsal böbrek ve üriner sistem anomalileri (DBÜSA) çocuklarda kronik böbrek hastalığının önde gelen nedenidir. DBÜSA gelişiminde genetik bozukluklar yanında, uygunsuz intrauterin koşulların da rol oynadığı düşünülmektedir. Çalışmada, DBÜSA olgularında antenatal etkenlerin rolü incelenmiştir. GEREÇ ve yÖNTEMLER:Çalışma grubuna DBÜSA tanılı 140 hasta, kontrol grubuna ise malformasyon olmaksızın üriner enfeksiyonu olan 140 olgu alındı. Gruplar antenatal (gestasyon süresi, prematürite, oligohidroamnioz, preeklampsi, gestasyonel diabetes mellitus, eşlik eden malformasyon, invitro fertilizasyon), maternal (gebelik yaşı, gebelik öncesi ağırlık, gebelikte ağırlık artışı, sistemik hastalık, sigara, alkol, ilaç ) ve ailesel (akraba evliliği, böbrek hastalığı, üriner anomali) parametreler yönünden karşılaştırıldı. BULGULAR:Çalışma grubunda gestasyon süresi daha kısa (38,8±2,9'a 39,5±0,9 hafta, p=0,004), prematürite oranı (%9,3'e %0,7, p=0,001), parite (≥2 gebelik oranı %57,9'a %41,4, p=0,006), oligohidramnioz (%6,4'e %0, p=0,002), eşlik eden malformasyon (%15,7'ye %5,7, p=0,007), gebelikte ağırlık artışı (18,8±2,9'e 18,1±2,8 kg, p=0,047) ve ailede böbrek hastalığı sıklığı (%7,9'a %2,1, p=0,028) daha yüksek idi. In vitro fertilizasyon uygulaması sadece çalışma grubundaki iki olguda mevcut idi.SONUÇ: DBÜSA için gebelikte fazla ağırlık artışı ve artan gebelik sayısı risk faktörü olabilir. Ancak, subfertilitenin rolünü tespit etmek için geniş kapsamlı çalışmalara gereksinim vardır.ANAHTAR SÖzCüKLER: Doğumsal böbrek ve üriner sistem anomalileri...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prenatal Risk Factors for Congenital Anomalies of the Kidney and Urinary Tract

Soylu¹,

Eroğlu²,

Türkmen³

et al. 2017

Turk Neph Dial Transpl

View full text Add to dashboard Cite

show abstract

“…Some meta‐analyses such as those accomplished by Hansen et al in and Rimm et al in have attempted to combine the data from these smaller studies to delineate the true association, but often with mixed and highly contested results (Hansen et al, , ; Rimm et al, ). Two important recent contributions have also been made with regard to the association between ART and congenital anomalies, an Australian study by Davies et al in and another meta‐analysis accomplished by Hansen et al in (Davies et al, ; Hansen et al, ), both of which support an increased contribution of congenital anomalies within the infertility population, especially those who have undergone ART.…”

Section: Introductionmentioning

confidence: 99%

Congenital anomalies identified at birth among infants born following assisted reproductive technology in colorado

Moses

Rasmussen

George

2014

Birth Defects Research

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“…

To the Editor Hansen et al [1] are critical of our study, [2] the primary goal of which is to raise awareness of the problem of having normal couples rather than subfertile couples comprise the control groups when estimating the odds of major malformation (MM) in the offspring of assisted reproductive technology (ART) pregnancies.We used only one study to estimate the impact of subfertility. This was because there is only one large study which offers usable data.

…”

mentioning

confidence: 99%

The impact of ART on major malformations is not known at this time

Rimm

Katayama

2012

J Assist Reprod Genet

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To the Editor Hansen et al. [1] are critical of our study, [2] the primary goal of which is to raise awareness of the problem of having normal couples rather than subfertile couples comprise the control groups when estimating the odds of major malformation (MM) in the offspring of assisted reproductive technology (ART) pregnancies.We used only one study to estimate the impact of subfertility. This was because there is only one large study which offers usable data. The fact that there is presently only one study that can be used for this purpose does not make this adjustment invalid or inappropriate because it was used only as a first estimate. At the present time, many investigators have noted that it is not possible to separate ART-related risks from those secondary to the underlying reproductive pathology.[3] Therefore we chose to work with such data as are available to make the point that there should be follow up on these ideas and that future studies should try to avoid repeating the mistake of the past regarding the use of inappropriate control groups. We may be the first to engage in a systematic effort to make this separation. We hope that future investigators will advance and refine this effort. We view our results as simply the first estimate of the effect of ART on MM rate when an appropriate control group, i.e., subfertile couples, is used.In reviewing the comments of Hansen et al. regarding the Place study, we noted an error in calculating the OR for the Place study. We thank Hansen et al. for pointing out this error. The 1.24 which appeared in Table 1 should have been 1.33. Hansen et al. also question why the hierarchical position of some studies on the second forest plot changed even further from the original. An adjustment factor must be used when there are zero patients with MM in either the ART or control group. In our first study, a .5 adjustment factor supplied by the meta-analysis program was used. In the second study, we used a .2 adjustment factor. This change made some relative changes in the odds ratios among the studies with a small number of patients. Those with a large number of patients changed very little. This would change the ranks from study one to study two because while some studies stayed in the same relative positions, others changed slightly. The adjustment of .2 is slightly better than that of .5. The program we used in 2004 automatically adjusted using .5 because it was programmed prior to 2003. Recent research suggests that .25 is the best adjustment. This adjustment is a standard meta-analysis technique. [4,5] Hansen et al. question the method we used to compute the adjusted ORs when the OR was less than one. They seem to be saying that if the adjustment causes an OR>1 to move closer to 1, then adjustment of an OR<1 should also cause it to move closer to 1. That is not correct; after adjustment, all ORs move "downward" or to the left and if they were already less than one, they will be even further away from one. To say this another way, if the original OR was already <1...

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ART, birth defects and subfertility—what should prospective patients be told?

Cited by 6 publications

References 12 publications

Prenatal Risk Factors for Congenital Anomalies of the Kidney and Urinary Tract

Prenatal Risk Factors for Congenital Anomalies of the Kidney and Urinary Tract

Congenital anomalies identified at birth among infants born following assisted reproductive technology in colorado

The impact of ART on major malformations is not known at this time

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