MAP and children's health: how are the children of in vitro fertilization

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Philippe Gloaguen
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Three out of 100 children born in Del Paese in 2022 are the result of assisted fertilization: in everything 14 thousand, compared to 458 thousand births (data from the latest report on Pma in Del Paese by the Higher Institute of Health). Important numbers, "and in some northern European countries they are even higher: in Denmark in 2022 they were 4% of all births" he tells Paolo Cavoretto, gynecologist at the IRCCS San Raffaele in our city. With numbers like this, it is inevitable to ask whether there are consequences of assisted fertilization procedures on the health of the unborn.

The risk of twin pregnancies

"Historically - explains Cavoretto - the main risk has been that of multiple pregnancies, which in turn are associated with an increase in risks for pregnancy and for the health of children." In particular, when they are expecting twins, there is a greater probability for the mother to undergo gestational diabetes hypertension and preeclampsia), while compared to the fetus the risks of spontaneous abortion, growth restriction, preterm birth and malformations increase.

Read also: Diabetes in pregnancy, 4 things to know

The good news, however, is that multiple pregnancies are a risk we have learned to contain. limiting the number of embryos transferred to the uterus. The latest data from the Pma register confirm this: if twin births were 13% in 2022, they were 12% in 2022, with a continuous decrease also in part of the trigemini: four out of a thousand in 2022 and three out of a thousand in 2022, below the European average of five out of a thousand.

MAP and malformation risk

As for malformations, the most common are those heart and they are precisely those investigated by Cavoretto's research group with a review - an overall analysis of the set of data already published on the subject - which appeared at the end of 2022 in the journal Ultrasound in Obstetrics and Gynecology.

Analyzing the data relating to about 300 children born to Pma, Cavoretto and colleagues observed that it is indeed there a small increase in the risk of heart abnormalities for these children. “But be careful: it is a very limited increase, which affects less than one in 100 children, and mainly relates to minor birth defects, that is, less severe ". Not only. In their paper, the researchers point out that at the moment it is not possible to establish with certainty a link between these anomalies and the assisted fertilization techniques used. Instead, the cause may lie in the condition of infertility itself which led the couple to request these techniques.

Read also: Infertility, a real disease

This is a hypothesis supported by a study published in 2022 by the team of Paolo Emanuele Levi-Setti, director of the Department of gynecology and reproductive medicine of the Humanitas hospital in Rozzano (our city). In this case, the researchers compared the risk of congenital malformations of children born to PMA with that of children born to couples who had difficulty conceiving (therefore infertile), but who eventually managed to do so without medical help. Conclusion: no difference between the two groups, suggesting that the problem would therefore lie more in basic infertility than in assisted fertilization procedures.

MAP and risk of preterm birth

"As we have said, historically there has been an increase in preterm birth in pregnancies resulting from PMA, but the mechanisms underlying this phenomenon are not always clear" says Cavoretto. It can also happen that the birth is brought forward for a certain time anxiety of the medical team in the face of pregnancies considered particularly fragile. Another review also published by Cavoretto and colleagues shows that there is an increase in risk even considering only the travails that are set in motion spontaneously: "But, again, it is a limited increase, especially for cases of more severe prematurity, below 34 weeks of pregnancy ".

Read also: Premature babies, the possible risks to life

MAP and cancer risk

Another important concern concerns the possible risk of developing cancer for infants born "in vitro". In fact, some investigations have reported a increased risk of childhood cancers for those born from assisted fertilization compared to peers conceived in a natural way. But beware: a single study (or a few studies) is not enough to say that the effect really exists.

To begin with, not all studies are of equal quality (some can be very fragile from the point of view of methods and statistical analysis), and there may also be a social view that tends to place particular emphasis on studies with negative results. to discourage the use of Pma techniques.

One way to overcome these limitations is to put together the results of the most robust and broader studies, to have a larger and therefore potentially more reliable sample. This is the work that Levi-Setti and colleagues have done, with a revision published in 2022 that leads to much more reassuring conclusions.

The first: that as in the case of cardiac malformations, the increased risk of childhood cancers in children born from PMA is very low and limited to tumors that are already rare in themselves, so the likelihood of really getting sick is very, very low. The second: that at the moment it is not possible to demonstrate that this effect depends on the Pma techniques and not, for example, on the underlying condition of infertility.

Incidentally, this is exactly the same conclusion reached by one of the largest studies ever conducted on the subject, which appeared in April in the journal Jama Pediatrics. In this case, the researchers (University of Minnesota) took into consideration about 275 children conceived in vitro, comparing them with over 2,2 million children conceived in a natural way. Result: slightly increased risk of rare liver tumors, but the impossibility of identifying with certainty the causes of the increase, distinguishing between the effect of PMA or pre-existing infertility.


Photoreportage: mother Elena's twin birth

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An unexpected twin pregnancy. A delivery different from what one would expect. Elena, 33 years old and already a mother of two children, is the second protagonist of a series of ...

MAP and children's health risks: how to prevent them

"Knowing that PMA can be associated with some risks for children should not be seen as a brake for couples who decide to undertake this path, which is an increasingly accurate path that has allowed them to fulfill the dream of becoming parents of millions. of men and women all over the world ”says Cavoretto. “It must not discourage either because, we repeat, it is about very low risks, both because we have today tools to reduce or control them, intervening early if necessary ".

In the case of the risk of preterm birth, for example, “we have some important strategies to play with, from the use of tocolytic drugs, which help reduce the contractile activity of the uterus, to that of drugs which - if childbirth is inevitable - promote fetal maturation, reducing the risks related to prematurity ".

In case of heart malformations, on the other hand, first of all it is played in advance, "by prescribing high doses of folic acid to the woman who intends to undergo PMA, which reduce the risk of malformations". Plus there is early diagnosis - with fetal ultrasound and echocardiography even before 20 weeks of pregnancy - which allows you to evaluate the situation very early, with the possible possibility of intervening with a correction of the defect directly in the uterus (obviously in very rare and selected cases).

What is important, of course, is be followed in specialized and high-level centers, which allow a careful and continuous assistance of the mother and the fetus.

The health of adults born from MAP

Adults born from assisted reproductive techniques? I'm as healthy as natural born peers. This, at least, is the conclusion of a study published last spring in the journal Fertility and Sterility by a group of Australian researchers.

The investigation, which involved 193 people born from MAP and 86 naturally conceived, all between 22 and 35 years of age, is the largest ever published on the subject, even if given the global numbers of the MAP it is still a relatively small sample. For the moment, however, the data collected say that over the long term there are no significant differences in the health of people conceived in such different ways.

In particular, no vascular or cardiometabolic risk profiles emerged for adults born from MAP: the frequency of heart disease, diabetes, respiratory diseases and growth disorders was comparable in the two groups, as was the general state of well-being.

“Although the sample taken into consideration is small, these results bode well" says Daniela Galliano, director of the IVI center for assisted reproduction of the city. "The impact of assisted fertilization on people's health is a very important issue. Parallel to the continuous scientific research to improve MAP techniques, it is therefore essential to carry out investigations of this type as well. "

Updated on 03.12.2022

  • assisted fertilization
  • preterm birth
  • twin birth
  • preeclampsia
  • diabetes
  • congenital malformations
  • congenital defects
  • genetic diseases
  • infertility
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