Fetal Complications During Pregnancy
There have now been over five million births worldwide following the use of assisted reproductive technology (ART) and the rates of assisted conceptions continue to rise. Hence any increase in adverse fetal outcomes resulting from the use of this technolo
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Fetal Complications During Pregnancy Catherine E.M. Aiken and Jeremy Brockelsby
Introduction Since the introduction of artificial reproductive technology (ART) into clinical practice in 1978 [1] there has been considerable concern regarding effects on the resulting fetus, and the long-term outcomes for the offspring. In particular, concerns were widely voiced that the ‘by-passing’ of normal gamete selection processes during conception would result in a much greater chance of children being born with genetic or structural anomalies. However, as more pregnancies following ART have been conceived and their outcomes reported, many of the initial fears have subsided. There have now been over five million births worldwide following the use of ART and the rates of assisted conceptions continue to rise [2]. In 2011, approximately 1.5 % of all pregnancies in the US were conceived using ART [3], hence any increase in adverse fetal outcomes resulting from the use of this technology would constitute a significant public health issue. While some perinatal complications are more common in fetuses resulting from ART, difficulties arise in many studies with defining the risk of complications that is attributable to the process of ART itself. There are a number of important confounding factors that may well contribute to adverse fetal outcomes in pregnancies conceived using ART, including the high incidence of: • Multiple pregnancies • Underlying subfertility
C.E.M. Aiken, PhD, MRCP, MRCOG Department of Fetal and Maternal Medicine, Addenbrooke’s Hospital, Cambridge, UK e-mail: [email protected] J. Brockelsby, MBBS, PhD, MRCOG (*) Department of Obstetrics and Gynaecology, Cambridge University Hospitals NHS Trust, Cambridge, UK e-mail: [email protected] © Springer International Publishing Switzerland 2017 K. Jayaprakasan, L. Kean (eds.), Clinical Management of Pregnancies following ART, DOI 10.1007/978-3-319-42858-1_10
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C.E.M. Aiken and J. Brockelsby
• Poor gamete quality • Advanced maternal age All of these factors contribute to increased risk for adverse fetal outcomes independent of the actual processes of assisted conception. Nonetheless pregnancies conceived using ART do have a higher risk of fetal complications, regardless of whether these have a causal association with the use of ART or are merely associated through other indirect factors such as maternal age. Perhaps most concerning for clinicians caring for couples who have undergone assisted conception are data from meta-analyses that show an increase in perinatal mortality following ART by up to 2.4-fold (OR 2.4; CI 1.59–3.63), even in singleton pregnancies [4, 5]. This chapter aims to examine the magnitude and the nature of increased fetal complications during pregnancies conceived using ART, and where possible to disentangle the mechanisms leading to an association between mode of conception and fetal complications. Early pregnancy loss prior to fetal development and later childhood outcomes are not considered in detail here as they are di
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