Observed Prevalence and Predictors of Congenital Heart Disease in Infants Conceived via In vitro Fertilization

Infants conceived via in vitro fertilization (IVF) have been reported to have increased rates of congenital heart disease (CHD), though estimates and associated risk factors remain variable. This study aimed to quantify CHD prevalence by severity sub-type and identify independent predictors of CHD in an IVF-conceived population. A retrospective cohort study of 1890 IVF-conceived infants born to 1783 mothers at a single tertiary academic center from 2020 to 2025 was performed. Maternal demographics, comorbidities, medication exposures, twin gestation, family history, and fetal echocardiography utilization were analyzed. CHD outcomes included: (1) any CHD; (2) persistent CHD (not spontaneously resolved within 3 years); and (3) significant CHD (requiring medical or procedural intervention). Prevalence was compared to the general population baseline (~1%) using Proportion Z testing. Multivariate logistic regression was performed to identify independent predictors. A sensitivity analysis excluded pregnancies with established CHD risk factors to isolate IVF-associated risk. CHD prevalence was 4.76% for any CHD, 3.33% for persistent, and 1.64% for significant. After exclusion of established CHD risk factors, prevalence decreased to 3.1%, 2.1%, and 1.01%, respectively. Fetal echocardiography utilization and diagnostic yield increased with CHD severity. Maternal hypertension, Black race, and Asian race independently predicted any CHD. However, only maternal hypertension predicted persistent CHD and only twin gestation predicted significant CHD. No independent associations were identified for maternal age, geography, median income, other medical conditions (i.e. diabetes, autoimmune), medication exposures, or family history. This IVF-conceived population showed a higher observed prevalence of CHD than global population baseline, though disease burden is driven by less severe heart disease. Distinct predictors varied by CHD severity subtype, supporting risk-stratified fetal echocardiography and individualized counseling in IVF pregnancies.