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ART and the Health of Babies
by Kimberly Lee, M.D.
Most couples being evaluated or treated for infertility have questions about the implications of Assisted Reproductive Therapy (ART) for the health of their babies-to-be. Many people may think of the McCaughey septuplets when they think of ART outcomes: multiple babies who stayed in utero more than 30 weeks, had relatively uneventful hospital stays, and all went home with apparently only minor problems. The McCaugheys’ story, while somewhat extreme (and associated with other aspects of ART, which should be discussed by a reproductive endocrinologist rather than a neonatologist), is actually illustrative of a few general principles about the “baby side” of ART.
The major health risk to babies conceived via ART is prematurity. To the extent that ART increases the like-lihood of multiple babies, it also increases the risk of premature delivery. For one thing, the uterus is sensitive to stretching, and the more babies there are, the more likelihood there is of premature contractions and labor. Also, with more than one baby, there is less room for their placentas. The resultant crowding can cause restriction of the babies’ blood supply and/or elevation of their mom’s blood pressure—problems which may cause an obstetrician to decide that a cesarean section must be performed before the “due date” for the sake of the babies’ and/or mother’s health.
The average gestational age for twins at delivery is 36 weeks, compared to 39 to 40 weeks for singletons; triplets are delivered at 33 weeks on average and quadruplets at 29 weeks. Any baby born before 37 weeks’ gestation is considered premature. However, there are differing degrees of prematurity. Since a “36-weeker” has had so much more time to develop, she is very likely to stay with her parents after delivery and go home with them from the hospital at the usual time. However, a “24-weeker” has about a 50-50 chance of survival since her lungs (and other organ systems) are just beginning to reach the point of development where they can function in the outside world. If she does survive, she faces long weeks and months of intensive care while she continues to develop the ability to breathe, eat, and stay warm on her own. Her parents can expect to take her home around the time of her due date, after many ups and downs and perhaps some scary complications along the way.
Babies’ development before “term” (37 to 42 weeks) follows a relatively predictable pattern, just as it does in older babies. All babies at 24 weeks are virtually unable to breathe on their own; by 30 weeks about half will; by 34 weeks nearly all will. They will usually begin to be able to coordinate their sucking and swallowing, and thus to start learning to nurse and/or bottle feed at 32 to 34 weeks; around the same time, they begin to develop the ability to regulate their own temperature without an incubator. Most babies master these skills by their due date. These milestones—breathing, eating, and staying warm without help—are the three major criteria most neonatologists use to tell when a baby is ready to leave the hospital.
It’s not all over once you leave the hospital. We do know that some premature babies may have problems
with their development as they grow up, including subtle problems with learning, which may not be predictable in the newborn period. Though I have no knowledge of their case, there have been news reports that two of the McCaugheys may have cerebral palsy, a movement disorder which can have varying degrees of severity. Like other prematurity-associated problems, this is more common, though certainly not the rule, in babies who were born at younger gestational ages.
Most published studies of ART “outcomes” look only at the rates of conception and/or delivery. There is evidence that the babies have no increased risk of visible abnormalities at birth, which is reassuring. However, while there is no reason to think that problems, in addition to those associated with prematurity, may show up later in life, there is no evidence yet that they won’t. The treatments haven’t been used for very long, and as far as I know there is no one carefully following large groups of kids conceived via ART to see how they are doing.
God is in control! I believe that His power and grace are released through the prayers of family, friends, and a supportive church family. The McCaugheys’ story certainly illustrates this well! But I know that there are those reading this article who have experienced a multiple pregnancy, and they have not had a positive outcome like the McCaugheys. I pray that you may experience God’s grace and power as you grieve your losses.
I know there are still others just starting down the road who, like me, ponder the implications of every decision we make regarding ART. We must realize that we have neither answers nor control, but realize as well that we must plead for His guidance. And I know that whatever happens, He is present with each one of us and truly cares.
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Kimberly G. Lee, M.D., M.S., I.B.C.L.C.
Board Certified Lactation Consultant
Medical Director of the BIDMC Lactation Service
Assistant Professor of Pediatrics, Harvard Medical School
Attending Neonatologist and Associate Director, Newborn Nursery, Beth Israel Deaconess Medical Center, Boston, Mass.
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