Objective

To study the incidence and clinical significance of congenital heart defects (CHDs) detected by fetal echocardiography in pregnancies conceived by in vitro fertilization (IVF).

Design

Cohort study comparing a prospectively maintained database of all fetal echocardiograms from 2012 to 2018 and pooled data from the Connecticut Birth Defects Registry and statewide hospital discharge data.

Setting

Large tertiary care center.

Patient(s)

A total of 181,749 live births and 9,252 fetal echocardiograms were analyzed. Fetal echocardiograms in patients with a previous child with a CHD, a family history of CHD, medication exposure, diabetes, anomaly in previous pregnancy, cardiac or other abnormality noted on previous ultrasound, or monochorionic twins were excluded from the final analysis.

Intervention(s)

Treatment with IVF.

Main Outcome Measure(s)

Incidence of CHD and odds ratios with 95% confidence intervals (CIs). Infant outcomes for cases of CHD were evaluated for clinically significant disease, defined a priori as disease requiring any medical or surgical intervention or continued follow-up with pediatric cardiology.

Result(s)

Fetal echocardiography was performed in 2,230 IVF pregnancies, of which 2,040 were without other known risk factors for CHD. The mean gestational age at the time of fetal echocardiography was 22.2 ± 1.4 weeks. The odds ratio for CHD in the IVF group compared with statewide population rates was 1.4 (95% CI 0.9–2.1). CHD was diagnosed in 26 fetuses, of which 21 were clinically insignificant ventricular septal defects. One fetal echocardiogram was concerning for pulmonary stenosis that was not present at birth. Four defects were clinically significant, indicating that 510 fetal echocardiograms were performed for every diagnosis of one clinically significant CHD in the IVF group.

Conclusion(s)

The incidence of CHD in IVF pregnancies without other risk factors is not significantly different from baseline population rates, and most CHDs diagnosed by fetal echocardiography in this group are clinically insignificant. Routine screening with fetal echocardiography in all IVF pregnancies provides limited utility beyond routine prenatal care and need not be recommended without the presence of other risk factors.

中文翻译：

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常规筛查胎儿超声心动图在体外受精妊娠中的应用

客观的

研究胎儿超声心动图检测到的先天性心脏缺陷 (CHD) 在体外受精 (IVF) 妊娠中的发生率和临床意义。

设计

队列研究比较了 2012 年至 2018 年所有胎儿超声心动图的前瞻性维护数据库以及来自康涅狄格州出生缺陷登记处和全州出院数据的汇总数据。

环境

大型三级护理中心。

耐心）

总共分析了 181,749 例活产和 9,252 例胎儿超声心动图。先前患有 CHD 的孩子、有 CHD 家族史、药物暴露、糖尿病、先前妊娠异常、先前超声发现的心脏或其他异常或单绒毛膜双胞胎的患者的胎儿超声心动图被排除在最终分析之外。

干预措施

体外受精治疗。

主要观察指标）

具有 95% 置信区间 (CI) 的 CHD 发生率和优势比。对 CHD 病例的婴儿结局进行评估，以确定是否有临床意义的疾病，先验定义为需要任何内科或外科干预或继续儿科心脏病学随访的疾病。

结果）

在 2,230 例 IVF 妊娠中进行了胎儿超声心动图检查，其中 2,040 例没有其他已知的 CHD 危险因素。胎儿超声心动图时的平均胎龄为 22.2 ± 1.4 周。与全州人口比率相比，IVF 组中 CHD 的优势比为 1.4（95% CI 0.9-2.1）。26 名胎儿被诊断为 CHD，其中 21 名是临床上无意义的室间隔缺损。一项胎儿超声心动图显示出生时不存在的肺动脉狭窄。四个缺陷具有临床意义，表明在 IVF 组中，每次诊断出 1 例具有临床意义的 CHD 都要进行 510 次胎儿超声心动图检查。

结论

在没有其他危险因素的 IVF 妊娠中，CHD 的发生率与基线人群发生率没有显着差异，并且该组中大多数通过胎儿超声心动图诊断的 CHD 在临床上不显着。在所有 IVF 妊娠中使用胎儿超声心动图进行常规筛查在常规产前保健之外的效用有限，如果不存在其他危险因素，则无需推荐。