A new Australian study has raised concerns over the potential risks associated with pregnancies resulting from assisted reproductive technologies (ART), such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), which may have higher exposure to teratogenic medications compared to naturally conceived pregnancies.
The research indicates that these pregnancies are more likely to be exposed to Category D and X medicines—substances classified by Australia’s Therapeutic Goods Administration (TGA) as potentially harmful to the developing fetus during the first trimester. While Category D medications may be prescribed if the clinical benefit outweighs the risks, particularly in the treatment of conditions like mental health disorders or epilepsy, Category X medications are strongly discouraged due to the high risk of fetal harm.
The study, conducted by researchers from the University of South Australia (UniSA), The University of Western Australia (UWA), and The Kids Research Institute, analyzed over 57,000 pregnancies from four different groups over a two-year period. The groups included women undergoing ART (2041), those using medications to induce ovulation (590), untreated sub-fertile women (2063), and naturally fertile women (52,987).
ART pregnancies were found to have the highest exposure to Category D medications during the first trimester, with 4.9% of ART pregnancies exposed to these drugs, compared to just 0.6% in naturally conceived pregnancies. This disparity continued into later trimesters, with 3.4% of ART pregnancies exposed to Category D medications versus 0.6% in the natural conception group.
Although exposure to Category X medications was low across all groups (less than 0.5%), the study highlights that ART pregnancies are more susceptible to drugs typically prescribed during fertility treatments, such as those used to prevent miscarriage or failed implantation, rather than those intended to treat underlying health conditions.
Dr. Anna Kemp-Casey, the lead researcher, emphasized that the differences in exposure largely stemmed from medications taken as part of ART protocols. The study identified paroxetine, lamotrigine, valproic acid, carbamazepine, and nicotine dependence treatments as the most commonly used Category D and X medications across all pregnancies.
Professor Roger Hart, a co-researcher and practicing IVF clinician, noted that the increased exposure to teratogenic medicines during the early stages of ART pregnancies could contribute to the higher rates of birth defects often observed in ART-conceived babies. While ART pregnancies are generally well-planned, the use of medications in fertility treatments may inadvertently increase the risks during critical fetal development stages.
Despite these findings, researchers emphasized that the majority of IVF babies are born healthy and that the study does not suggest ART pregnancies are unsafe. The results highlight the importance of personalized medical care for women undergoing ART, with particular attention given to medication use during early pregnancy.
Professor Hart stressed the need for further research into the effects of Category D and X medications during pregnancy, as well as the role of underlying maternal health conditions in influencing the risk of birth defects in ART pregnancies.
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