Dados do Trabalho

Title

PERINATAL IMPACTS RELATED TO ASSISTED REPRODUCTION TECHNIQUES

Objective

This literature review seeks to examine the perinatal ramifications associated with Assisted Reproduction Techniques (ART).

Methods

The research utilized the Boolean Operators '(Assisted Reproductive Techniques) AND (Child Development OR Health Risks OR Related Health Problems OR Child Health)' to conduct a comprehensive search. Databases such as U.S. National Library of Medicine (PUBMED), Biblioteca Virtural em Saúde (BVS) and Cochrane were employed. The initial search included filters for free articles and publications between 2018 and 2023. In the PUBMED database, strict selection criteria focused on clinical trials, meta-analyses, randomized clinical studies, and systematic reviews, yielding 203 articles. Conversely, the BVS and Cochrane databases allowed unrestricted study types, generating 191 and 46 articles, respectively. After meticulous review and exclusion of irrelevant and duplicate studies, 49 articles remained. The final selection encompassed 10 articles, chosen based on robust evidence and minimal methodological limitations.

Results

The body of research on children conceived through Assisted Reproduction Techniques (ART) suggests a higher susceptibility to unfavorable perinatal outcomes when compared to natural conceptions. These outcomes include twinning, imprinting disorders, gestational complications, and cancer, with the probability of these risks varying based on the specific ART technique utilized.

A systematic review revealed a 43% higher risk of congenital defects in children conceived through ART compared to those conceived naturally. Notably, prematurity and very low birth weight emerged as the most significant perinatal risks associated with ART conceptions. Consistent with these findings, a Canadian study also reported substantially higher risks for adverse perinatal outcomes linked to ART, such as twinning, cesarean delivery, and prematurity. Moreover, children conceived through ART displayed a significantly higher association with complex chronic conditions at one year of age compared to those from spontaneous pregnancies.

Furthermore, studies analyzing the correlation between congenital defects and the incidence of childhood cancer found that ART conception increased the risks of non-chromosomal congenital defects. Additionally, these defects appeared to heighten the baseline risk of developing cancer in affected individuals.

The increase in the rate of monozygotic and monochorionic twinning was also linked to ART in a meta-analysis and systematic review, particularly when embryo transfer occurred at the cleavage stage and in women under 35 years old.

When it comes to imprinting disorders, research indicated that the risk was significantly higher in children conceived through ART, with Neonatal Diabetes Mellitus (NDM) being the most associated condition. Nonetheless, the authors of these studies highlighted the potential influence of various factors such as the type of female infertility, mode of conception, obesity, and diabetes, which could have affected the observed results. On the other hand, a Danish study suggested that existing results on the risk of imprinting disorders were ambiguous and that such an association might be limited to specific cases, such as Beckwith-Wiedemann Syndrome.

Overall, these findings underscore the need for continued research to better understand the potential risks and implications associated with ART-conceived pregnancies, considering various contributing factors and the specific techniques employed.

Conclusion

Children conceived through Assisted Reproduction Techniques (ART) exhibit higher risks of adverse perinatal outcomes and congenital defects compared to spontaneous conceptions. ART methods vary in their specific risks. However, some studies stress the importance of considering confounding factors like twinning, parental age, comorbidities, and subfertility when evaluating these findings. Epigenetic alterations, notably imprinting disorders, may be induced by ART, as suggested by the literature. Fortunately, the risks associated with ART have been progressively declining over time due to advancements and safer technique selection.

Keywords

Assisted reproductive techniques; birth defects; child health risk; perinatal outcomes