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<p>Against the backdrop of declining global fertility rates, assisted reproductive technology (ART) is increasingly critical in helping infertile couples achieve live birth. However, it is associated with elevated risks of preterm birth (PTB) and congenital heart disease (CHD). This population-based cohort study, comprising 115,553 singleton live births in Jing’an District, Shanghai (2013–2020), sought to quantify the impact of ART on PTB and CHD and to evaluate PTB as a potential mediating role, with a focus on early preterm birth (&lt; 34 weeks). During the study period, the total number of births declined from 17,581 to 9,426, whereas the proportion of ART-conceived offspring increased from 1.46% to 8.40%, representing a 5.77-fold increase. ART-conceived singletons had significantly higher risks of PTB (adjusted OR = 1.14) and CHD (adjusted OR = 1.51). Mediation analysis indicated that PTB mediated 5.27% of the total ART–CHD association, with early preterm birth (&lt; 34 weeks) accounting for 10.78%. Upon stratification by maternal age, this mediating effect was significant only among mothers aged &lt; 35 years, with a mediation proportion of 14.97% for early preterm birth. This study provides novel evidence that PTB, particularly early preterm birth, partially mediates the ART–CHD pathway, especially in younger mothers. These findings underscore the importance of targeted perinatal care and early surveillance in ART-conceived pregnancies to mitigate the risk of CHD and improve offspring health outcomes.</p>

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Congenital heart disease in singleton infants conceived through assisted reproductive technology: a population-based cohort study in China

  • 期刊论文

  • 发表日期：

    2025年12月1日

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  • Qiuping Wan,
  • Xin Cui,
  • Naisi Qian,
  • Shan Jin,
  • Yunhui Wang,
  • Xiaoting Chu,
  • Chunfang Wang,
  • Xiaoming Yang,
  • Huiting Yu

摘要

Against the backdrop of declining global fertility rates, assisted reproductive technology (ART) is increasingly critical in helping infertile couples achieve live birth. However, it is associated with elevated risks of preterm birth (PTB) and congenital heart disease (CHD). This population-based cohort study, comprising 115,553 singleton live births in Jing’an District, Shanghai (2013–2020), sought to quantify the impact of ART on PTB and CHD and to evaluate PTB as a potential mediating role, with a focus on early preterm birth (< 34 weeks). During the study period, the total number of births declined from 17,581 to 9,426, whereas the proportion of ART-conceived offspring increased from 1.46% to 8.40%, representing a 5.77-fold increase. ART-conceived singletons had significantly higher risks of PTB (adjusted OR = 1.14) and CHD (adjusted OR = 1.51). Mediation analysis indicated that PTB mediated 5.27% of the total ART–CHD association, with early preterm birth (< 34 weeks) accounting for 10.78%. Upon stratification by maternal age, this mediating effect was significant only among mothers aged < 35 years, with a mediation proportion of 14.97% for early preterm birth. This study provides novel evidence that PTB, particularly early preterm birth, partially mediates the ART–CHD pathway, especially in younger mothers. These findings underscore the importance of targeted perinatal care and early surveillance in ART-conceived pregnancies to mitigate the risk of CHD and improve offspring health outcomes.