Does assisted reproductive technology influence the complexity and associated malformations in esophageal atresia?

Purpose: Assisted reproductive technology (ART) has been associated with increased risks of congenital anomalies and preterm birth. However, its role in influencing the complexity of specific malformations, such as esophageal atresia (EA), remains unclear. This study aimed to assess whether ART impacts the phenotypic complexity of EA, including associated anomalies and VACTERL (vertebral, anal, cardiac, tracheoesophageal, renal, and limb anomalies) association. Methods: Data from 374 EA patients enrolled in the European Pediatric Surgeons' Association (EUPSA) Esophageal Atresia Registry were analyzed. Patients were grouped based on mode of conception (28 ART and 346 natural conception) and compared for demographics, gestational age, birth weight, associated malformations, VACTERL association, and genetic disorders. Results: Gestational age and birth weight were comparable between groups (36.5 ± 3.3 vs. 36.4 ± 3.3 weeks, p = 0.42; 2412.3 ± 761.6 g vs. 2601.3 ± 744.3 g, p = 0.24). Maternal age was significantly higher in the ART group. The prevalence of cardiac, gastrointestinal, renal, musculoskeletal, and vertebral anomalies did not differ significantly. All cardiac anomalies in ART patients were minor. VACTERL association rates (25.0% vs. 18.5%, p = 0.398) and genetic disorder prevalence (7.1% vs. 4.9%, p = 0.605) were comparable. Conclusions: ART does not appear to increase the complexity of EA in terms of associated malformations, VACTERL spectrum disorders, or genetic abnormalities. Further studies with larger cohorts and detailed ART subtype data are warranted to confirm these findings.