PREGNANT PEOPLE
Concerns over maternity provision for pregnant women in UK prisons
Gaps in maternal health in prisons are due to barriers to healthcare provision, say experts
BMJ Group
Senior midwives and researchers with experience in criminal and social justice are among those calling for improved maternity provision for pregnant women in UK prisons.
In an article published by The BMJ today, Laura Abbott and colleagues highlight gaps in clinical care for pregnant women and say the systemic problems need tackling urgently to protect the health of pregnant women, new mothers, and babies while in criminal justice settings.
Figures from April 2023 to March 2024 show that 229 pregnant women were held in prison in England and 53 gave birth during this time.
Research on the care of pregnant women in prison in the UK is sparse, but shows that pregnant women in prison are less likely to receive antenatal appointments and face heightened risks of complications and mental health difficulties than the general population.
This was highlighted by the suicide of Michelle Barnes in 2015, five days after she learnt she was to be separated from her baby, and ombudsman investigations into the deaths of two babies born in prison. These tragedies and the campaigns of organisations including Birth Companions has led to new sentencing guidance acknowledging pregnancy and the post-birth period as mitigating factors and the need for specialised support for women who are separated from their babies.
“Whenever possible, we should avoid incarceration for pregnant women and prioritise viable community based alternatives,” say Abbott and colleagues. However, they state that as long as pregnant women remain in prison, the maternity care they receive must be appropriate and of high and consistent quality.
They note that improvements have been made in response to recent reports, including in-cell telephones, assigned pregnancy mother and baby liaison officers, and increased maternity cover, but stress that prison services do not match the accessibility of NHS services.
Until alternatives to imprisonment become routinely used for pregnant women, they suggest several actions to enhance maternity care within prison settings.
These include protected midwife time, obstetric clinics within prisons, and multidisciplinary training of care providers. Specialised support should also be provided to help mitigate adverse effects of mandatory separation in the critical 1001 days of life.
They also point to several community initiatives as examples of how, with funding, alternatives to imprisonment can be transformative for women and their babies.
“The deaths of mothers and babies within the prison system highlight the urgency of addressing current deficiencies and continue to galvanise our collaborative endeavours to advance maternity care provision in prison while also working to avoid the incarceration of perinatal women in all but the most exceptional of circumstances,” they write.
“Concerted efforts are needed from healthcare providers, policy makers, third sector organisations, and prison authorities to effect positive changes.”
Finally, they say it is important not to view prison as a place of safety for vulnerable pregnant women. “The challenge lies in creating alternatives that offer the same level of support for their complex needs,” they conclude.
[Ends]
Journal
The BMJ
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
Improving maternity provision for incarcerated women in the UK
Article Publication Date
15-Jan-2025
COI Statement
We have read and understood BMJ policy on declaration of interests declare that LA co-founded the global network Pregnancy in Prison Partnership International and the Prison Midwives Action Group.
Sharp drop in mortality after 41 weeks of pregnancy
University of Gothenburg
image:
Karin Källén, Lund University, and Ulla-Britt Wennerholm, University of Gothenburg.
view moreCredit: Photo: Ingemar Hultquist, Margareta G. Kubista
The proportion of babies dying before and during labor after 41 weeks of gestation has fallen by 47% in Sweden in a relatively short time. This is the result of a major national study. The reduction has occurred since the procedures around induction have changed.
A pregnancy normally lasts around 40 weeks. However, a fairly high proportion of women, 22%, pass their due date and are pregnant for 41 weeks or longer. Although Sweden generally has a very low risk of stillbirth and death within the first month of life, the risk increases the longer the pregnancy continues past 41 weeks of gestation. The question that then arises is whether the woman should be induced.
The current study, published in the journal PLOS Medicine, is based on registry data on more than 150,000 births in Sweden where the women were one week or more after the expected date of delivery.
The aim was to investigate how infant mortality and morbidity in late-term births have changed since 2020, when most maternity hospitals in the country changed their practices for induction.
The new procedures were a response to research findings from 2019 that showed that fewer infants died if women were induced as early as after 41 gestational weeks, compared to 42, which was the standard practice at the time. The shift in 2020 meant a more active management where women began to be offered induction at 41 weeks or individual assessment of whether induction was needed.
Risk almost halved
When the researchers now compare the periods 2017-2019 and 2020-2023 (until September 2023 (incl.)), the results show a 47% decrease in the proportion of stillbirths or infants dying within four weeks. In the first period, 124 infants (1.7 per 1 000) and in the second period 74 infants (0.9 per 1 000) died during labor after 41 gestational weeks or more. The periods covered approximately the same number of these births.
The study also shows that a composite measure of mortality and severe morbidity in the neonatal period was lower in the latter group, after 2020. At the same time, there was a slight increase in the rate of emergency caesarean sections, but the rate of caesarean sections increased even more in gestational week 39-40.
Researchers are unable to determine exactly which interventions led to the improved survival of the children. It is therefore unclear whether this is mainly due to routine induction after 41 gestational weeks or whether intensive monitoring is sufficient to select women who should be recommended for induction.
One of the driving forces behind the study is Karin Källén, Statistician and Professor of Clinical Epidemiology in Obstetrics and Gynecology at Lund University:
“The results show a clear decrease in both neonatal death and severe morbidity and an increase in the number of inductions and emergency cesarean sections. With around 22 000 women annually in Sweden still pregnant at 41 weeks, 18 infant deaths have been prevented annually, says Karin Källén.
Good scientific basis
Ulla-Britt Wennerholm is Adjunct Professor of Obstetrics and Gynecology at Sahlgrenska Academy, University of Gothenburg. She also had a major research role in SWEPIS (Swedish Postterm Induction Study), published in 2019, which led to the change in care routines.
“The present study gives support for a more active management with induction or individual assessment at 41 weeks. The difference between the pre- and post-2020 periods was large, but at the same time it is important to emphasize that the absolute risk to an individual woman and her baby is very small, regardless of whether the delivery takes place after 41 or 42 weeks,” she says.
The study in PLOS Medicine is based on data from the National Pregnancy Registry, the Swedish Neonatal Quality Registry and Statistics Sweden. The women included were at least one week overdue and had low-risk pregnancies in the sense that they were healthy, were expecting a baby in an occipito-anterior (head first) position and had not previously had a caesarean section.
Journal
PLOS Medicine
Method of Research
Observational study
Subject of Research
People
Article Title
Maternal and perinatal outcomes after implementation of a more active management in late- and postterm pregnancies in Sweden: a population-based cohort study
Article Publication Date
16-Jan-2025
Risk of stillbirth and newborn death before 28 days was almost halved in “overdue” pregnancies lasting beyond 41 weeks, in nationwide Swedish study offering active management and induction of labor
image:
Every expectant parent wishes for a healthy child.
view moreCredit: PublicDomainPictures, Pixabay (CC0, https://creativecommons.org/publicdomain/zero/1.0/)
In your coverage, please use this URL to provide access to the freely available paper in PLOS Medicine: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004504
Article title: Maternal and perinatal outcomes after implementation of a more active management in late- and postterm pregnancies in Sweden: A population-based cohort study
Author countries: Sweden
Funding: see manuscript
Journal
PLOS Medicine
Method of Research
Observational study
Subject of Research
People
How improving education could close maternal heart health gaps
Northwestern study examines how social, environmental factors drive disparities in heart health for Black and Hispanic mothers
Northwestern University
- Social factors, not biology, explain nearly all racial disparities in maternal heart health
CHICAGO --- Research has established a clear link between racial and ethnic disparities in maternal heart health and higher risks of preterm birth, preeclampsia and cardiovascular issues for Black and Hispanic mothers and their babies.
Now, a new Northwestern study dives deeper into these disparities and discovered a powerful insight: achieving equity in various social drivers of health — but particularly education — could nearly eliminate these gaps. Additional education, along with factors such as income and access to healthcare, could reduce the heart health gap between Black and white women by 82% and erase it entirely between Hispanic and white women.
In other words, social and environmental factors — not biological differences at birth — drive steep disparities in cardiovascular health during pregnancy.
The study published on Jan. 14 in Circulation: Cardiovascular Quality and Outcomes.
“If racial and ethnic groups achieved the same average years of education, the gaps in heart health between the groups could be substantially reduced,” said first author Dr. Natalie Cameron, an instructor of general internal medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician.
“The pathways linking education to heart health are complex and may be related to income, health insurance, access to health care and health-related knowledge,” Cameron added.
How the study was done
Northwestern scientists analyzed data collected during the beginning of pregnancy from 9,104 participants in the Nulliparous Pregnancy Outcomes Study, who self-identified as Hispanic, non-Hispanic Black or non-Hispanic white.
The team began by calculating participants’ cardiovascular health scores, which were based on six factors: blood pressure, body weight, exercise levels, diet, smoking behavior and sleep. They then determined how these scores differed between the groups.
To explore what drove the differences, the scientists analyzed self-reported data on individual and neighborhood-level factors such as maternal age, education, income, health insurance, mental health, racial discrimination and neighborhood deprivation.
Using statistical methods, the scientists found that the individual- and
neighborhood-level factors explained all differences in cardiovascular health between Hispanic and white participants, and 82% of the differences between Black and white participants.
The scientists also found that educational attainment had the largest impact on maternal cardiovascular health disparities.
Call for action
These findings support a growing body of literature emphasizing the power that social and environmental factors have on health. Other Northwestern scientists recently calculated similar results in non-pregnant populations.
Cameron says reform is needed at multiple levels to address racial and ethnic differences in heart health, starting even before pregnancy.
“From a public health standpoint, we need to improve access to healthy foods, build environments where people can safely walk and play and improve access to preventive healthcare. Researchers and policy makers need to partner with communities to make sure these changes are implemented in ways that support their neighborhoods and wellbeing.”
Cameron adds that healthcare systems and providers must play an active role in screening for social determinants of health early in life, before pregnancy.
“If a specific need is identified, providers can connect patients with social workers and community resources to help address these needs,” she said.
With the new findings in mind, Cameron says the next steps are to “design, implement and test the effectiveness of programs that address these social and environmental factors in improving heart health before pregnancy.”
The study was supported by the National Institutes of Health/National Heart Lung and Blood Institute (R01 HL161514).
Journal
Circulation Cardiovascular Quality and Outcomes
Shocking cues
How cells harness electric fields to migrate during embryonic development
Technische Universität Dresden
image:
Spheres represent cells swimming down an electric sea
view moreCredit: Julien Marcetteau for the Barriga Lab/PoL
As an embryo grows, there is a continuous stream of communication between cells to form tissues and organs. Cells need to read numerous cues from their environment, and these may be chemical or mechanical in nature. However, these alone cannot explain collective cell migration, and a large body of evidence suggested that movement may also happen in response to embryonic electric fields. How, and where these fields are established within embryos, was unclear until now. “We have characterised an endogenous bioelectric current pattern, which resembles an electric field during development, and demonstrated that this current can guide migration of a cell population known as the neural crest”, highlights Dr. Elias H. Barriga, the corresponding author who led the study. Initially, Dr Barriga and his team began research on the neural crest at the former Gulbenkian Institute of Science (IGC) in Oeiras, Portugal before continuing research in Dresden, establishing a group at the Cluster of Excellence Physics of Life.
The neural crest is an essential part of the embryo, and this region of cells forms the bones of our face and neck, as well as parts of the nervous system. Dr. Barriga and colleagues found that cells of the neural crest are directed by internal electric fields during development, much like drivers follow the signals of a traffic warden. The group discovered that through this process, known as electrotaxis, cells can sense direction from electric fields generated inside the embryo and move accordingly. This observation had been previously limited mostly to the study of cultured cells, but now was demonstrated within a developing embryo. But an important question remained unanswered: How are the cells interpreting these currents and translating them into directional movement?
To answer this question, Dr. Barriga and his team identified an enzyme known as voltage-sensitive phosphatase 1 (Vsp1) found in neural crest cells. Due to the versatile structure of Vsp1, it seemed capable of both sensing and transducing electrical signals. To confirm that Vsp1 is required for electrotaxis, the researchers created a defective version of the enzyme and showed that collective electrotaxis was impaired in cells injected with this copy. “For me, applying tools I developed to target gene expression in the context of bioelectricity was highly rewarding, and I look forward to its potential being fully exploited” highlighted Dr. Sofia Moreira, a postdoctoral scientist who worked on the study. Contrary to expectations, Vsp1 did not appear to be relevant for movement itself, but instead could specifically convert electric current gradients into directional and collective migration. This is a unique observation, as most enzyme sensors are required for movement itself, making it difficult to study their role in guiding direction. Going one step further, the authors also proposed how the electric fields may form; through mechanical stretching of a region known as the neural fold. As the cells in this region stretch, this causes activation of specific ion channels, resulting in a voltage gradient. Then, when cells encounter this gradient, Vsp1 transforms the electrical signals into a directional cue, telling the cells which way to go, and collective cell migration results.
This is the first experimental evidence to suggest that electric fields emerge along the path where neural crest cells migrate, and to explain their mechanism of origin. These discoveries highlight a valuable contribution that bioelectricity provides during embryonic development. By advancing our knowledge of electrotaxis within a living animal, this research opens new possibilities for mimicking developmental processes in the lab, with accuracy greater than ever before. The first author of the study, postdoctoral scientist Dr. Fernando Ferreira notes “This paper bridges an important, decades-old gap in bioelectricity research, and it is deeply rewarding to be part of the ongoing renaissance in developmental bioelectricity”. However, research into the mechanisms of electrotaxis is still ongoing. “In a broader perspective, we have now introduced another player into the intricate process of tissue morphogenesis” notes Dr. Barriga. “The question is now, how does this fit into already established frameworks of mechanical and chemical cues during embryogenesis?”. Beyond development, similar mechanisms might also exist during wound healing and cancer progression. Understanding how electric fields guide cell migration could even inspire potential novel strategies in tissue engineering and regenerative medicine. However, further research is required to expand on the role of electric fields in cellular behaviour, and increase our understanding of the physics behind living systems.
Investigators: Fernando Ferreira, Sofia Moreira, Min Zhao, and Elias H. Barriga
Funding: This work was supported by grants from the European Research Council Starting Grant (ERC-StG) under the European Union’s Horizon 2020 research and innovation programme, grant agreement no. 950254 (to E.H.B.); The European Molecular Biology Organization (EMBO) Installation Grant, project no. 4765 (to E.H.B.); EMBO Young Investigator program, project no. 5248 (to E.H.B.); EMBO postdoctoral fellowship, ALTF 27-2020 (to F.F.); La Caixa Junior Leader Incoming, no. 94978 (to E.H.B.); and Fundação para a Ciência e a Tecnologia (FCT) postdoctoral fellowship, 2020.00759.CEECIND (to S.M.). Research by E.H.B. was also supported by the IGC, Fundação Calouste Gulbenkian (FCG), start-up grant I-411133.01, and from the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany’s Excellence Strategy (EXC 2068, 390729961), Cluster of Excellence Physics of Life of TU Dresden.
Study: Fernando Ferreira, Sofia Moreira, Min Zhao, and Elias H. Barriga. Nature Materials. DOI: 10.1038/s41563-024-02060-2
About the Cluster of Excellence, Physics of Life:
Physics of Life (PoL) is one of three clusters of excellence at TU Dresden. It focuses on identifying the physical laws underlying the organization of life in molecules, cells, and tissues. In the cluster, scientists from physics, biology, and computer science investigate how active matter in cells and tissues organizes itself into given structures and gives rise to life. PoL is funded by the DFG within the framework of the Excellence Strategy. It is a cooperation between scientists of the TU Dresden and research institutions of the DRESDEN-concept network, such as the Max Planck Institute for Molecular Cell Biology and Genetics (MPI-CBG), the Max Planck Institute for the Physics of Complex Systems (MPI-PKS), the Leibniz Institute of Polymer Research (IPF) and the Helmholtz-Zentrum Dresden-Rossendorf (HZDR). www.physics-of-life.tu-dresden.de
Journal
Nature Materials
Subject of Research
Cells
Article Publication Date
17-Jan-2025
New survey finds over half of Americans are unaware that bariatric surgery can improve fertility
Experts say surgery is the most permanent and effective treatment for obesity that helps women achieve healthy pregnancies
Orlando Health
video:
New survey finds over half of Americans are unaware that bariatric surgery can improve fertility
view moreCredit: Orlando Health
St. Petersburg, Fla - Welcoming a newborn is something many couples dream of doing, but it can get complicated when conceiving becomes a roadblock. Infertility affects one in six people, but obesity can also be a problem. When diet and exercise aren’t enough to lose weight, bariatric surgery can become an option. Yet a new national survey by Orlando Health finds that 56% of Americans do not know that bariatric surgery is an effective way to improve fertility.
“Every day we have more patients who are looking for bariatric surgery as a solution for several medical conditions, including infertility,” said Alexander Ramirez, MD, FASMBS, Director of Orlando Health Weight Loss & Bariatric Institute - Bayfront. “When female patients are struggling with obesity and pregnancy, there is typically a correlation between their weight and infertility.”
The survey highlighted Americans' lack of knowledge of this correlation. When asked if they agree with the statement that being overweight negatively affects fertility, half (50%) responded that they either don't know or neither agree nor disagree with that statement.
Obesity is a chronic disease that presents many serious health conditions, including diabetes, hypertension, sleep apnea and the increased risk of several different cancers. And additionally for women struggling with obesity; irregular menstrual cycles, hormone imbalances, and even polycystic ovarian syndrome (PCOS) – can all contribute to infertility.
“We have many patients with PCOS, a hormonal condition that affects women of reproductive age, many of whom try and fail to get pregnant for many years,” said Ramirez. “After bariatric surgery, their chances of conception drastically increase very quickly as their hormones are regulated and their menstrual cycle normalizes.”
Although other weight loss options, like GLP-1 medications may seem like the easier solution, the survey also revealed 64% of people either don’t know or neither agree/disagree that stopping GLP-1 injections can lead to weight gain. Ramirez says bariatric surgery is usually the more effective and longer-lasting option, as it permanently alters the digestive system, increasing the production of hormones and helping the body to ovulate.
“We want women to become pregnant at the right moment, when it's the right time in their lives and also when it’s safe,” said Ramirez, who recommends waiting between 18 to 24 months before trying to conceive after bariatric surgery.
By waiting, the body is able to recover and adjust to the changes from surgery, including digesting the right amount of nutrients. Ramirez says this transitional period helps decrease complications during pregnancy, including hypertension, preeclampsia and gestational diabetes.
For 38-year-old Karla Grimmett, bariatric surgery became a necessity when her type two diabetes, driven by obesity, landed her in the intensive care unit. Grimmett weighed 380 pounds and knew a gastric bypass procedure was the best decision for her health. Yet, she never imagined it would also correct her fertility issues.
“I’ve been told since I was 11 that I would never have kids because of polycystic ovarian syndrome,” said Grimmett. “I've always been overweight. And because of all my medical issues with high blood pressure and all of that, they just said it was never going to happen.”
After bariatric surgery, her health began to improve. She went from taking 12 medical prescriptions a day to two, and she had a regular menstrual cycle for the first time in years.
“Right after I had surgery, I started getting it every single month like clockwork, no issues. And then when it didn't come in April, I was like, ‘It can't be,’” said Grimmett. “And I went and got a pregnancy test and I still didn't believe it, so I went and bought four more.”
Grimmett gave birth to her daughter, Everleigh, in November of 2022, something she never dreamed was possible.
“She's full of life. She keeps me on my toes, but she's definitely the best thing that ever happened to me,” said Grimmett. “I had just given up hope that I would ever get pregnant and have a child.”
Dr. Ramirez says it’s important for people to understand the connection between obesity and serious health issues, including infertility. For those who are unable to achieve a healthy weight through lifestyle interventions like diet and exercise, it may be time to speak to your doctor about bariatric surgery.
“My advice for anyone with obesity, and especially for those who want to have a child, is to ask about bariatric surgery because it's the most powerful tool we have to lose weight in a healthy way and keep obesity in remission,” said Ramirez. “And that is going to increase their chances of having a successful and healthy pregnancy.“
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Survey Methodology
This survey was conducted online within the United States by Ipsos on the KnowledgePanel®️ from December 6 - 8, 2024, and surveyed 1,019 U.S. adults ages 18 and older. This poll is based on a nationally representative probability sample and has margin of sampling error of plus or minus 3.3 percentage points at the 95 percent confidence level, for results based on the entire sample of adults. For complete survey methodology, including weighting variables and subgroup sample sizes, please contact: christopher.moessner@ipsos.com.
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Courtesy: Orlando Health
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About Orlando Health
Orlando Health is a private not-for-profit, integrated academic healthcare system with $12 billion of assets under management, that serves the southeastern United States – including Florida and Alabama – and Puerto Rico. With corporate offices in Orlando, Florida the system provides a complete continuum of care across a network of medical centers and institutes, community and specialty hospitals, physician practices, urgent care facilities, skilled nursing facilities, home healthcare, and long-term and behavioral health care services. Founded more than 100 years ago, Orlando Health’s mission is to improve the health and the quality of life of the individuals and communities we serve. The system provided nearly $1.7 billion in community impact in the form of community benefit programs and services, Medicare shortfalls, bad debt, community-building activities and capital investments in FY 23, the most recent period for which the information is available. For more information, visit orlandohealth.com, or follow us on LinkedIn, Facebook, Instagram and X (formerly Twitter.)
Method of Research
Survey
Subject of Research
People
Karla Grimmett dropped over 200-pounds after a gastric bypass procedure at Orlando Health Weight Loss and Bariatric Surgery Institute. This helped her overcome several serious health conditions, including diabetes, high blood pressure, high cholesterol and polycystic ovarian syndrome (PCOS), as well as helping her achieve something she never thought was possible—having a child.
A new national survey by Orlando Health finds 56% of Americans are unaware that bariatric surgery improves fertility. Alexander Ramirez, MD, FASMBS, director of Orlando Health Weight Loss & Bariatric Institute - Bayfront explains this to each of his patients and suggests waiting 18 to 24 months before trying to conceive after surgery.
Credit
Orlando Health
Jinfeng pill shows potential to improve ovarian response and restore female fertility
image:
HE staining used to observe the number and distribution of ovarian follicles at all levels in each group
view moreCredit: All authors (Li Yi et al.)
As delayed pregnancies become more common, poor ovarian response (POR) is a growing challenge for assisted reproductive technology (ART). A new study conducted by researchers from Xiamen University and Huaqiao University, China explores the potential of Jinfeng pill, a traditional Chinese medicine, to improve ovarian function in rats with induced POR.
The study, published in Reproductive and Developmental Medicine, investigates how Jinfeng pill affects ovarian size, follicle development, and hormone levels of POR rats. They were treated with estradiol (E2), Jinfeng pill, or both.
The results showed that Jinfeng pill treatment—either alone or combined with estradiol—led to larger ovaries, more follicles at various stages of development, and enhanced ovarian blood flow in POR rat model. The combination therapy produced the most significant improvements, including increased vascular endothelial growth factor (VEGF) expression, which is associated with better blood circulation in the ovaries.
In terms of hormones, the combined treatment lowered follicle-stimulating hormone (FSH) levels and slightly increased anti-Müllerian hormone (AMH), a key marker of ovarian reserve. While the changes were not statistically significant in all groups, they suggest that the Jinfeng pill can support ovarian function by balancing hormones and improving follicular health.
The corresponding authors of this study commented, "Our study provides valuable insights into how Jinfeng pill could enhance ovarian function of POR rat, especially by improving blood flow and hormone regulation. With further research, we hope to expand these findings to human clinical trials, offering more effective treatments for women with poor ovarian response."
Journal
Reproductive and Developmental Medicine
Article Title
Effect of Jinfeng Pill on ovarian function of Tripterygium wilfordii polyglycoside tablets induced poor ovarian response rats
IVF pregnancies at greater risk of exposure to medicines that can harm the fetus
A new Australian study has revealed a potential reason why some pregnancies achieved through assisted reproductive technology (ART) may result in birth defects in comparison to naturally conceived pregnancies.
Researchers found that in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) pregnancies had the highest exposure to teratogenic medicines that potentially can harm the fetus during the first trimester of pregnancy.
These are listed as Category D and X medicines by Australia’s Therapeutic Goods Administration (TGA).
The risk associated with the use of Category D medicines in pregnancy may be outweighed by the clinical benefit in individual cases such as management of mental health disorders or epilepsy. Category X medicines on the other hand are strongly discouraged during pregnancy due to the high risk of fetal harm.
Researchers from the University of South Australia (UniSA), The University of Western Australia (UWA) and The Kids Research Institute Australia analysed more than 57,000 pregnancies in four conception groups over a two-year period. The groups comprised women using ART (2041); those taking medication to induce ovulation (590); untreated sub-fertile women (2063); and naturally fertile pregnancies (52,987).
ART pregnancies had the highest exposure to Category D medications taken in the first trimester.
The study found that 4.9% of the ART pregnancies were exposed, compared to only 0.6% of naturally conceived pregnancies.
In later trimesters, the trend persisted, with 3.4% of ART pregnancies exposed to Category D medications versus 0.6% of naturally conceived pregnancies.
Exposure to Category X medications (causing the most harm during pregnancy) was low across all groups and trimesters, at less than 0.5% of pregnancies.
“These differences in exposure are primarily linked to medications used as additional treatment following ART to prevent repeat miscarriages or failed implantation, rather than medications to treat underlying chronic conditions,” says UniSA researcher Dr Anna Kemp-Casey, who led the study.
“For example, ART pregnancies, during the study period were more often exposed to progestogens like medroxyprogesterone acetate, which may have been used to treat threatened or recurrent miscarriages,” Dr Kemp says.
The five most frequently used Category D/X medications across all pregnancies regardless of conception status were paroxetine, lamotrigine, valproic acid, carbamazepine, and nicotine dependence treatments.
UWA co-researcher Professor Roger Hart, also a practising IVF clinician and the national medical director of City Fertility, says the higher exposure to Category D and X medicines in ART pregnancies during the first trimester may contribute to the higher rate of birth defects observed in ART babies.
“Although ART pregnancies are carefully planned, medications taken during fertility treatments may inadvertently increase exposure to birth defect risks, particularly during critical periods of fetal development,” Prof Hart says.
Researchers say the findings demonstrate that the vast majority of IVF babies are healthy, and do not suggest that ART pregnancies are unsafe, but they underscore the importance of personalised medical care for women undergoing ART treatment and close monitoring for women in early pregnancy.
Prof Hart says more research is needed to examine Category D and X medicines exposure in pregnancy as well as underlying maternal medical conditions and their contribution to birth defect risk in ART babies.
The study has been published in the Australian and New Zealand Journal of Obstetrics and Gynaecology.
Notes for editors
“Are assisted reproductive technology pregnancies more likely to be exposed to teratogenic medication? A whole-population study” is authored by researchers from the University of South Australia, Telethon Kids Institute, The University of Western Australia and Curtin University. DOI: 10.1111/ajo.13911
According to the latest ANZARD report, in 2022 more than 20,000 children in Australia (17,963) and New Zealand (2095) were born using ART. Since IVF was introduced in 1978, 10 million children have been born using ART.
A 2021 study by US researchers analysing 1.2 million births found an 18% higher risk of birth defects among IVF babies and a 36% overall greater risk for ICSI births (42% increased risk where ICSI was used to treat male factor subfertility and 30% increased risk with ICSI use for non-male factor subfertility).
In IVF pregnancies, sperm is added to a dish containing eggs, and fertilisation occurs naturally, compared to ICSI where a single sperm is injected directly into each egg. The latter procedure is normally used to treat male subfertility but is also an option for unexplained infertility.
Journal
Australian and New Zealand Journal of Obstetrics and Gynaecology
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
Are assisted reproductive technology pregnancies more likely to be exposed to teratogenic medication? A whole-population study”
