Assisted reproductive techniques and the risk of anorectal malformations: a German case-control study

Weih Sandra, Reifferscheid Peter, Kujath Christina, Obermayr Florian, Bartels Enrika, Brenner Hermann, Zwink Nadine, Jenetzky Ekkehart, Schmiedeke Eberhard, Schmidt Dominik, Märzheuser Stefanie, Grasshoff-Derr Sabine, Holland-Cunz Stefan, Hosie Stuart, Ameis Helen, Rißmann Anke, Schwarzer Nicole, Reutter Heiko, Cure-Net Consortium

Description

The use of assisted reproductive techniques (ART) for treatment of infertility is increasing rapidly worldwide. However, various health effects have been reported including a higher risk of congenital malformations. Therefore, we assessed the risk of anorectal malformations (ARM) after in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Methods Data of the German Network for Congenital Uro-REctal malformations (CURE-Net) were compared to nationwide data of the German IVF register and the Federal Statistical Office (DESTATIS). Odds ratios (95% confidence intervals) were determined to quantify associations using multivariable logistic regression accounting for potential confounding or interaction by plurality of births. Results In total, 295 ARM patients born between 1997 and 2011 in Germany, who were recruited through participating pediatric surgeries from all over Germany and the German self-help organisation SoMA, were included. Controls were all German live-births (n = 10,069,986) born between 1997 and 2010. Overall, 30 cases (10%) and 129,982 controls (1%) were born after IVF or ICSI, which translates to an odds ratio (95% confidence interval) of 8.7 (5.9–12.6) between ART and ARM in bivariate analyses. Separate analyses showed a significantly increased risk for ARM after IVF (OR, 10.9; 95% CI, 6.2–19.0; P < 0.0001) as well as after ICSI (OR, 7.5; 95% CI, 4.6–12.2; P < 0.0001). Furthermore, separate analyses of patients with isolated ARM, ARM with associated anomalies and those with a VATER/VACTERL association showed strong associations with ART (ORs 4.9, 11.9 and 7.9, respectively). After stratification for plurality of birth, the corresponding odds ratios (95% confidence intervals) were 7.7 (4.6–12.7) for singletons and 4.9 (2.4–10.1) for multiple births. Conclusions There is a strongly increased risk for ARM among children born after ART. Elevations of risk were seen after both IVF and ICSI. Further, separate analyses of patients with isolated ARM, ARM with associated anomalies and those with a VATER/VACTERL association showed increased .

Sujets

• Imperforate anus
• Reproductive medicine

Informations

• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 11
• Langue: English

Extrait

Zwinket al. Orphanet Journal of Rare Diseases2012,7:65 http://www.ojrd.com/content/7/1/65

R E S E A R C HOpen Access Assisted reproductive techniques and the risk of anorectal malformations: a German casecontrol study

1 1,2*3 44 Nadine Zwink , Ekkehart Jenetzky, Eberhard Schmiedeke , Dominik Schmidt , Stefanie Märzheuser , 5 66 78 9 Sabine GrasshoffDerr , Stefan HollandCunz , Sandra Weih , Stuart Hosie , Peter Reifferscheid , Helen Ameis , 10 1112 1314 14,15 Christina Kujath, Anke Rißmann, Florian Obermayr, Nicole Schwarzer, Enrika Bartels, Heiko Reutter, 1 Hermann Brennerand CURENet Consortium

Abstract Background:The use of assisted reproductive techniques (ART) for treatment of infertility is increasing rapidly worldwide. However, various health effects have been reported including a higher risk of congenital malformations. Therefore, we assessed the risk of anorectal malformations (ARM) after invitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Methods:Data of the German Network for Congenital UroREctal malformations (CURENet) were compared to nationwide data of the German IVF register and the Federal Statistical Office (DESTATIS). Odds ratios (95% confidence intervals) were determined to quantify associations using multivariable logistic regression accounting for potential confounding or interaction by plurality of births. Results:In total, 295 ARM patients born between 1997 and 2011 in Germany, who were recruited through participating pediatric surgeries from all over Germany and the German selfhelp organisation SoMA, were included. Controls were all German livebirths (n= 10,069,986)born between 1997 and 2010. Overall, 30 cases (10%) and 129,982 controls (1%) were born after IVF or ICSI, which translates to an odds ratio (95% confidence interval) of 8.7 (5.9–12.6) between ART and ARM in bivariate analyses. Separate analyses showed a significantly increased risk for ARM after IVF (OR, 10.9; 95% CI, 6.2–< 0.0001)as well as after ICSI (OR, 7.5; 95% CI, 4.619.0; P–12.2; P< 0.0001). Furthermore, separate analyses of patients with isolated ARM, ARM with associated anomalies and those with a VATER/VACTERL association showed strong associations with ART (ORs 4.9, 11.9 and 7.9, respectively). After stratification for plurality of birth, the corresponding odds ratios (95% confidence intervals) were 7.7 (4.6–12.7) for singletons and 4.9 (2.4–10.1) for multiple births. Conclusions:is a strongly increased risk for ARM among children born after ART. Elevations of risk were seenThere after both IVF and ICSI. Further, separate analyses of patients with isolated ARM, ARM with associated anomalies and those with a VATER/VACTERL association showed increased risks in each group. An increased risk of ARM was also seen among both singletons and multiple births. Keywords:Anorectal malformation, Imperforate anus, Anal atresia, Reproductive medicine, Assisted reproductive techniques

* Correspondence: jenetzky@curenet.de 1 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany 2 Department for Child and Adolescent Psychiatry, Johannes GutenbergUniversity, Mainz, Germany Full list of author information is available at the end of the article

© 2012 Zwink et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.