Optimal Follow-Up Duration for Assessment of Birth Defects After In Vitro Fertilization-Embryo Transfer: A
Chun-Lin Liu1, Ping Li2, Gui-Feng Cai3
1Center for Reproductive Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Insights
A 5-year follow-up study found that birth defects in children conceived via assisted reproductive technologies (ART) increased over time. A 3-year follow-up is recommended for optimal assessment of ART-conceived infant health.
Area of Science:
- Reproductive Medicine
- Pediatrics
- Public Health
Background:
- Assisted reproductive technologies (ART) are increasingly used globally.
- Concerns exist regarding potential long-term health outcomes, including birth defects, in ART-conceived children.
- Longitudinal data is crucial for understanding the full spectrum of these outcomes.
Purpose of the Study:
- To evaluate the cumulative incidence of birth defects in children conceived via ART over a 5-year period.
- To determine the optimal duration of follow-up for identifying birth defects in this population.
Main Methods:
- A 5-year cohort study involving 1,985 infants born from ART procedures across three centers.
- Data collection via phone interviews at 7 days, 1, 3, and 5 years post-birth.
- Tracking diagnosis, category, and timing of birth defects.
Main Results:
- The cumulative incidence of birth defects identified increased from 2.7% at 7 days to 5.6% by 5 years post-birth.
- A significant proportion of defects (45.3%) were diagnosed within the first week of life, with others identified up to 5 years.
- Follow-up response rates decreased over time, from 99.9% at 7 days to 64.5% at 5 years.
Conclusions:
- Extended follow-up is necessary to capture the full incidence of birth defects in ART-conceived children.
- A 1-year follow-up is the minimum recommended, while a 3-year follow-up offers an optimal balance between completeness and resource allocation.
Objective:
To investigate the impact of a 5-year follow-up on the incidence of identified birth defects in children conceived using assisted reproductive technologies (ART).
Methods:
A 5-year cohort study was performed in three ART centers from January 2013 to October 2018. 1,543 women with 1,985 infants who delivered successfully or underwent termination of pregnancy due to malformations were recruited in this study. Follow-up was conducted by phone interview, 7 days, 1 year, 3 years, and 5 years after birth. Collected data included whether one or more birth defects were diagnosed, the category of birth defects, and when the malformation was diagnosed. Cumulative incidence of birth defects and the loss to follow-up rate of each follow-up was compared.
Results:
According to the diagnostic criterion of birth defects, 111 cases of one or more birth defects were recorded, with a total of 117 birth defects after the 5-year follow-up. 0.2% (4/1,985) of birth defects were diagnosed before delivery; 2.7% (54/1,985) at 7 days; 5.0% (100/1,985) after 1 year; 5.5% (109/1,985) after 3 years; and 5.6% (111/1,985) after 5 years. 3.4% (4/117) of defects were diagnosed prenatally, 45.3% (53/117) of defects diagnosed within the first 7 days after delivery, 40.2% (47/117) diagnosed during 7 days to 1 year, and 9.4% (11/117) of defects diagnosed in 1-3 years after birth. The remaining 1.7% (2/117) of defects were diagnosed between the ages of 3 and 5 years. Among the 1,543 patients, 99.9% patients (1,542/1,543) responded to the telephone interview at 7 days after delivery; the response rate was 89.0% (1,373/1,543) at 1 year, 81% (1,250/1,543) at 3 years, and 64.5% (995/1,543) after 5 years.
Conclusion:
We suggest that in ART, 1-year follow-up should be the minimum requirement and 3-year follow up the optimal length of follow-up that balances resource requirements with ascertainment completeness.
