Received March 22, 2021
Accepted September 30, 2021

Purpose: Investigation of the incidence of fetal heart defects and its risk factors in assisted reproductive technology (ART)-induced pregnancies compared to natural pregnancies. Methods: In this retrospective cohort study, data were collected from the medical records belonging to 2877 pregnant women's fetuses, who underwent fetal echocardiography for various reasons, including ART, over the last 3 years. Results: No major cardiac anomaly was found in ART-induced pregnancies while it was seen in 1.32 % of natural pregnancies; so, ART did not increase the risk of major cardiac anomalies. However, the incidence rate of fetal mild cardiac anomalies among fetuses derived from ART-induced pregnancies (51.43 %) was significantly higher than that of in natural pregnancies (44.43 %, P= 0.03). None of the ART-induced pregnancies had a history of a child with cardiac disease (vs 7.56 % in natural pregnancies). Also, the increased nuchal thickness (NT) and extra-cardiac anomalies were significantly more prevalent among natural pregnancies, indicating a significant negative correlation between ART and these two risk factors [χ2 = 10.24, r: - 0.06, 95% CI(-0.0974 to -0.0221) and χ2 = 47.25, r: -0.129, 95% CI(-0.1656 to -0.0913), P<0.01, respectively]. The adjusted Odd of developing fetal mild cardiac anomalies were 1.37 times greater for ART-induced pregnancy compared to natural pregnancy [95% CI(1.072_1.769), P=0.01]. Conclusion: Although the likelihood of developing fetal mild cardiac anomalies was 1.37 times greater for ART-induced pregnancy compared to natural pregnancy, ART did not increase the risk of major cardiac anomalies.