Impact of assisted reproductive technology on the risk of cerebral palsy: A systematic review and meta-analysis.

Objective: The aim of this study was to evaluate the impact of assisted reproductive technology (ART) on the risk of cerebral palsy (CP) in offspring. Methods: We searched PubMed, Embase, Web of Science and Scopus databases for observational studies that investigated the link between ART and CP as a pregnancy outcome that were published until 15th January, 2024. Only studies that provided adjusted effect sizes for the outcome of interest were included. Pooled odds ratio (OR) was reported along with 95% confidence intervals (CI). Results: Thirteen studies were included. Pregnancy that was achieved with the help of ART correlated with significantly higher risk of CP in offspring (OR 1.51, 95% CI: 1.18, 1.94) compared to natural conception. The risk of CP in singleton pregnancies achieved through ART was elevated (OR 1.31, 95% CI: 1.09, 1.58). while no such increase in the risk was detected in cases of multiple pregnancies (OR 1.07, 95% CI: 0.95, 1.20) and preterm births (OR 1.09, 95% CI: 0.93, 1.28). Studies published prior to the year 2010 showed an association of ART with elevated rates of CP (OR 1.67, 95% CI: 1.14, 2.44). No difference was detected in studies published after the year 2010 (OR 1.40, 95% CI: 0.97, 2.03). Conclusion: Our findings suggest a modest increase in the risk of CP that is linked to ART. However, the analysis is hindered by a small number of studies and notable heterogeneity. Subgroup analyses did not show significant associations for multiple or preterm pregnancies, suggesting that other factors beyond ART may be responsible. Factors such as maternal age, underlying infertility, and pregnancy complications might contribute to the observed risk of CP rather than ART itself. Higher-quality studies are required to validate our conclusions.