臨床婦人科産科76巻11号

2022年11月発行

今月の臨床 生殖医療の安全性―どんなリスクと留意点があるのか？

受精卵，児・家族への影響

先天性心疾患と循環器系異常

著者： 森本美仁¹ 小谷友美² 加藤太一¹

所属機関： ¹名古屋大学医学部附属病院小児科 ²名古屋大学医学部附属病院総合周産期母子医療センター

ページ範囲：P.1123 - P.1128

文献概要

●高齢出産の増加と生殖補助医療の進歩により，日本で生殖補助医療（ART）によって妊娠し出生した児（ART由来出生児）は全新生児14人に1人（2019年）まで増加しており，世界のなかでも特に高い割合にある．

●ART由来出生児が自然妊娠群と比較して先天性心疾患（CHD）を合併するリスクが高いことについてはさまざまな意見があり，コンセンサスは得られていない．

●ART妊娠は，日本胎児心臓病学会ガイドラインでは胎児CHD合併のハイリスク妊娠には分類されていないが，米国のガイドラインではハイリスク妊娠に分類されている．

参考文献

1）Hirahara F : Intracytoplasmic sperm injection and birth defects. J Mamm Ova Res 30 : 149-154, 2013

2）Adamson GD, et al : International Committee for Monitoring Assisted Reproductive Technology : world report on assisted reproductive technology, 2011. Fertil Steril 110 : 1067-1080, 2011

3）Sato T, et al : Preimplantation genetic testing for aneuploidy : a comparison of live birth rates in patients with recurrent pregnancy loss due to embryonic aneuploidy or recurrent implantation failure. Hum Reprod 34 : 2340-2348, 2019

4）Lytzen R, et al : Live-born major congenital heart disease in Denmark : incidence, detection rate, and termination of pregnancy rate from 1996 to 2013. JAMA Cardiol 3 : 829-837, 2018

5）Colaco SM, et al : Neonates with critical congenital heart defects : impact of fetal diagnosis on immediate and short-term outcomes. Ann Pediatr Cardiol 10 : 126-130, 2017

6）松岡瑠美子，他 ; 日本小児循環器学会疫学委員会 : 先天性心血管疾患の疫学調査―1990年4月〜1999年7月，2，654，家族の報告．日小児循環器会誌19 : 606-621, 2003

7）Jenkins KJ, et al : Noninherited risk factors and congenital cardiovascular defects : current knowledge : a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young : endorsed by the American Academy of Pediatrics. Circulation 115 : 2995-3014, 2007

8）Feng Y, et al : Maternal reproductive history and the risk of congenital heart defects in offspring : a systematic review and meta-analysis. Pediatr Cardiol 36 : 253-263, 2015

9）Iwashima S, et al : Reproductive technologies and the risk of congenital heart defects. Hum Fertil（Camb） 20 : 14-21, 2017

10）Han Y, et al : Congenital anomalies in infants conceived by infertile women through assisted reproductive technology : a cohort study 2004 2014. Exp Ther Med 16 : 3179-3185, 2018

11）Shamshirsaz AA, et al : Cyanotic congenital heart disease following fertility treatments in the United States from 2011 to 2014. Heart 104 : 945-948, 2018

12）Galdini A, et al : Prevalence of congenital heart defects in pregnancies conceived by assisted reproductive technology : a cohort study. J Clin Med 10 : 5363, 2021

13）Giorgione V, et al : Congenital heart defects in IVF/ICSI pregnancy : systematic review and meta-analysis. Ultrasound Obstet Gynecol 51 : 33-42, 2018

14）Morimoto Y, et al : Conception by assisted reproductive technology in infants with critical congenital heart disease in Japan. Reprod Biomed Online 44 : 163-170, 2022

15）Tararbit K, et al : Risk of congenital heart defects associated with assisted reproductive technologies : a population-based evaluation. Eur Heart J 32 : 500-508, 2011

16）Wang C, et al : Association of assisted reproductive technology, germline de novo mutations and congenital heart defects in a prospective birth cohort study. Cell Res 31 : 919-928, 2021

17）Giorgione V, et al : Adverse perinatal outcome and placental abnormalities in pregnancies with major fetal congenital heart defects : a retrospective case-control study. Prenat Diagn 40 : 1390-1397, 2020

18）Inversetti A, et al : Prenatal growth in fetuses with isolated cyanotic and non-cyanotic congenital heart defects. Fetal Diagn Ther 47 : 411-419, 2020

19）Matsui H, et al : Initial national investigation of the prenatal diagnosis of congenital heart malformations in Japan-Regional Detection Rate and Emergency Transfer from 2013 to 2017. J Cardiol 78 : 480-486, 2021

20）Bakker MK, et al : Prenatal diagnosis and prevalence of critical congenital heart defects : an international retrospective cohort study. BMJ Open 9 : e028139, 2019

21）Allan L, et al ; Fetal Cardiology Working Group ; Association for European Paediatric Cardiology : Recommendations for the practice of fetal cardiology in Europe. Cardiol Young 14 : 109-114, 2004

22）Wood D, et al ; World Association of Perinatal Medicine Ultrasonography Working Group : Perinatal echocardiography : protocols for evaluating the fetal and neonatal heart. J Perinat Med 37 : 5-11, 2009

23）日本胎児心臓病学会（編） : 日本小児循環器学会胎児エコー検査ガイドライン（第2版）．日小児循環器会誌37（S1） : S1.1-S1.57, 2021