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Abstract
BACKGROUND Previous research has examined the relationship between advanced parental age at conception and the incidence of autism, and has noted strong relationships between advanced parental age and other developmental disabilities. AIM The purpose of this study was to confirm that and extend that knowledge to the association between advanced parental age and severity of autism symptoms as measured by a parental report of ASD symptom severity. METHODS The current study included 252 participants between the ages of 2-17 years and their parents. RESULTS Child's gender and paternal age were found to be significant predictors of autism severity with males and children with older fathers at conception showing the highest severity. Interestingly, maternal age was not found to be a significant predictor of autism risk or severity of symptoms in this sample. CONCLUSION Possible explanations for these findings are discussed, as well as future directions for research in this area.
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Legro RS, Diamond MP, Coutifaris C, Schlaff WD, Alvero R, Casson P, Christman GM, Rosen RM, Cedars MI, Hansen KR, Robinson R, Baker V, Usadi R, Dodson WC, Estes SJ, Kunselman A, Stetter C, Barnhart KT, Coward RM, Trussell JC, Krawetz SA, Santoro N, Huang H, Zhang H, Eisenberg E. Pregnancy registry: three-year follow-up of children conceived from letrozole, clomiphene, or gonadotropins. Fertil Steril 2020; 113:1005-1013. [PMID: 32386612 DOI: 10.1016/j.fertnstert.2019.12.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the development of children conceived from non-IVF infertility treatments consisting of gonadotropins, clomiphene, or letrozole. DESIGN Prospective cohort study. SETTING U.S. academic health centers. PATIENT(S) Children of women with polycystic ovary syndrome who conceived with letrozole (LTZ) or clomiphene (CC) in the PPCOS II study or women with unexplained infertility (AMIGOS study) who conceived with LTZ, CC, or gonadotropin (GN). INTERVENTION(S) Longitudinal annual follow-up from birth to age 3. MAIN OUTCOME MEASURE(S) Scores from Ages and Stages Developmental Questionnaire (ASQ), MacArthur-Bates Communicative Development Inventory (MCDI), and annual growth. RESULT(S) One hundred eighty-five children from 160 families participated in at least one follow-up evaluation from the two infertility trials. Most multiple gestations in the follow-up study resulted from GN treatment (n = 14) followed by CC (n = 6) and LTZ (n = 3). There were no significant differences among the three groups at any time point with respect to abnormal scores on the ASQ. On the MCDI Words and Gestures, the LTZ group scored significantly higher than the GN group for most items (phrases, early gestures, later gestures, and total gestures). Children in the CC group scored significantly higher than the GN group for the later gestures and total gestures items. CONCLUSION(S) Differences in growth and cognitive developmental rates among children conceived with first-line infertility therapies, including LTZ, are relatively minor and likely due to differences in multiple pregnancy rates.
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Affiliation(s)
- Richard S Legro
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William D Schlaff
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado
| | - Ruben Alvero
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado
| | - Peter Casson
- Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont
| | - Gregory M Christman
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - R Mitchell Rosen
- Department of Obstetrics and Gynecology, University of California at San Francisco, San Francisco, California
| | - Marcelle I Cedars
- Department of Obstetrics and Gynecology, University of California at San Francisco, San Francisco, California
| | - Karl R Hansen
- Department of Obstetrics and Gynecology University of Oklahoma, Oklahoma City, Oklahoma
| | - Randal Robinson
- Department of Obstetrics and Gynecology, University of Texas at San Antonio, San Antonio, Texas
| | - Valerie Baker
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California
| | - Rebecca Usadi
- Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina
| | - William C Dodson
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Stephanie J Estes
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Allen Kunselman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Christina Stetter
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Kurt T Barnhart
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado
| | - R Matthew Coward
- Department of Urology, University of North Carolina, Raleigh, North Carolina; UNC Fertility LLC, Raleigh, North Carolina
| | - J C Trussell
- Department of Urology, SUNY Upstate University Hospital, Syracuse, New York
| | - Stephen A Krawetz
- Department of Obstetrics and Gynecology and Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado
| | - Hao Huang
- Department of Biostatistics, Yale University, New Haven, Connecticut
| | - Heping Zhang
- Department of Biostatistics, Yale University, New Haven, Connecticut
| | - Esther Eisenberg
- Fertility and Infertility Branch, National Institute of Child Health and Human Development, Rockville, Maryland
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Miller V, Diamond MP, Hansen KR, Steiner AZ, Cedars M, Legro RS, Krawetz SA, Coutifaris C, Huang H, Santoro N, Zhang H. Families with children resulting from ART: psychosocial and financial implications. Hum Reprod Open 2020; 2020:hoaa010. [PMID: 32309638 PMCID: PMC7152781 DOI: 10.1093/hropen/hoaa010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/10/2020] [Indexed: 11/25/2022] Open
Abstract
STUDY QUESTION What are the psychosocial and financial issues experienced among families with children 2-12 years of age conceived by ART? SUMMARY ANSWER Our results suggest that families with children, 2-12 years of age, conceived via ART are doing well, although impacts were identified on parents of twins and higher-order multiples. WHAT IS KNOWN ALREADY Multiple births have been associated with higher morbidity and mortality of children, as well as financial costs to families and society. STUDY DESIGN SIZE DURATION This study was an assessment of familial response to birth of singletons, twins and higher order multiples at child's ages of 2-12. PARTICIPANTS/MATERIALS SETTING METHODS Semi-structured interviews and surveys were conducted with mothers (n = 348) and fathers (n = 338) of singletons, twins and higher-order multiple gestations who received fertility services. MAIN RESULTS AND THE ROLE OF CHANCE No significant differences were observed between the groups in domains of primary caregiving or parental separation/divorce. Impacts were identified on parent's ability to maintain employment. The revised 15-item scores of the Impact on Family Scale were significantly lower, reflecting more negative impacts, among families with twins (beta = -2.6, 95% confidence interval (CI), -4.7, -0.5, P = 0.014) and multiples (beta = -7.4, 95% CI, -10.4, -4.5, P < 0.001) than among families with singletons. Similarly, the Parenting Stress Index total scores were significantly lower among families with twins and multiples, indicating greater levels of stress, when compared to those with singletons. In addition, the Beck Depression Inventory total score were significantly higher for twins and multiples, and the Child Behaviour Checklist for ages 1.5-5 total problem score was significantly higher for twins when compared to singletons. LIMITATIONS REASONS FOR CAUTION The study was limited to families who received fertility treatment and constitutes a population that was well educated and had higher incomes. Additionally, interview data was self-reported. STUDY FUNDING/COMPETING INTERESTS This work was supported by National Institutes of Health (NIH)/Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) U10 HD39005 (to M.P.D.), U10 HD077680 (to K.R.H.), U10 HD077844 (to A.Z.), U10 HD077841 (to M.C.), U10 HD38992 (to R.S.L.), U10 HD27049 (to C.C.), U10 HD055925 (to H.Z.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NICHD or NIH.Dr Virginia Miller-no conflicts; Dr Michael P. Diamond-NIH Funding, AbbVie, Bayer and ObsEva Funding; Board of Directors and Stockholder for Advanced Reproductive Care; Dr Karl R. Hansen-Yale University/Reproductive Medicine Network/NICHD, Roche Diagnostics and Ferring International Pharmascience Center US funding; Dr Anne Steiner-NIH Funding; Dr Marcelle I. Cedars-no conflicts; Dr Richard Legro-consultant for Ogeda, Millendo, Kindex and Bayer; Ferring and Astra Zeneca funding; Dr Stephen A. Krawetz-no conflicts; Dr Christos Coutifaris-NIH Funding; Dr Hao Huang-no conflicts; Dr Nanette Santoro-no conflicts; Dr Heping Zhang-NIH Funding. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Virginia Miller
- Division of Population Health Sciences, University of Alaska, Anchorage, AK 99508, USA
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA 30912, USA
| | - Karl R Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA
| | - Anne Z Steiner
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Marcelle Cedars
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA 94143, USA
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, PA 16802, USA
| | - Stephen A Krawetz
- Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI 48202, USA
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Hao Huang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT 06520, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado, Denver, CO 80204, USA
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT 06520, USA
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Zeltzer J, Shand AW, Kelly P, Hopper JL, Scurrah KJ, Nassar N. Early birth is a key factor in educational disadvantage of twins: A data linkage study. Acta Paediatr 2020; 109:534-540. [PMID: 31402475 DOI: 10.1111/apa.14966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/03/2019] [Accepted: 08/09/2019] [Indexed: 11/26/2022]
Abstract
AIM To assess educational outcomes of twins and quantify the degree this is mediated by gestational age and other perinatal factors. METHODS We conducted a population-based record-linkage cohort study of all live births ≥24 weeks gestation in New South Wales, Australia with a corresponding standardised school test result for grade 3 in 2008-2014. The primary outcome was whether a child met the National Minimum Standard (NMS) cut-off in literacy and numeracy domains. Robust multivariable Poisson models were used to obtain adjusted relative risks (aRRs), and mediation analysis conducted to assess contributing factors on the causal pathway. RESULTS Of 351 791 liveborn infants, 10 365 (2.9%) were twins. After adjusting for maternal covariates and compared with singletons, twins had an increased risk of not meeting the NMS for all five literacy and numeracy domains (aRR 1.27-1.45, P < .001). Gestational age alone mediated up to 73% of aRRs and small for gestational age further attenuated these effects with only minimal risk remaining after adjusting for all mediators (aRR 0.94-1.07). CONCLUSION Almost all of the educational disadvantage experienced by twins, compared with singletons, is attributable to the risk associated with shorter gestational age, and partly by poor foetal growth. These findings support efforts to prolong gestation of twin pregnancies.
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Affiliation(s)
- Justin Zeltzer
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School University of Sydney Sydney NSW Australia
| | - Antonia W. Shand
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School University of Sydney Sydney NSW Australia
- Maternal Fetal Medicine Department Royal Hospital for Women Randwick NSW Australia
| | - Patrick Kelly
- School of Public Health University of Sydney Sydney NSW Australia
| | - John L. Hopper
- Twins Research Australia, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health University of Melbourne Melbourne Vic. Australia
| | - Katrina J. Scurrah
- Twins Research Australia, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health University of Melbourne Melbourne Vic. Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School University of Sydney Sydney NSW Australia
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Hoorsan H, Mirmiran P, Chaichian S, Moradi Y, Hoorsan R, Jesmi F. Congenital Malformations in Infants of Mothers Undergoing Assisted Reproductive Technologies: A Systematic Review and Meta-analysis Study. J Prev Med Public Health 2018; 50:347-360. [PMID: 29207452 PMCID: PMC5717326 DOI: 10.3961/jpmph.16.122] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 06/20/2017] [Indexed: 11/22/2022] Open
Abstract
Objectives This meta-analysis aimed to evaluate congenital malformations in infants conceived by assisted reproductive techniques (ART), compared with infants conceived spontaneously. Methods In this study, available resources searched to find relevant articles included PubMed, ScienceDirect, Scopus, Google Scholar, Cochrane, ProQuest, Iranmedex, Magiran, and Scientific Information Database. After extracting the necessary information from evaluated articles, meta-analysis on the articles’ data was performed using Stata version 11.2. Results In this study, from a total of 339 articles, extracted from the initial investigation, ultimately 30 articles were selected for meta-analysis that assessed the use of ART on the risk of congenital abnormalities and some birth complications on 5 470 181 infants (315 402 cases and 5 154 779 controls). The odds ratio (95% confidence interval [CI]) for low birth weight was 1.89 (95% CI, 1.36 to 2.62), preterm labor 1.79 (95% CI, 1.21 to 2.63), cardiac abnormalities 1.43 (95% CI, 1.27 to 1.62), central nervous system abnormalities 1.36 (95% CI, 1.10 to 1.70), urogenital system abnormalities 1.58 (95% CI, 1.28 to 1.94), musculoskeletal disorders 1.35 (95% CI, 1.12 to 1.64), and chromosomal abnormalities in infants conceived by ART was 1.14 (95% CI, 0.90 to 1.44), which were all statistically significant, except chromosomal abnormalities. Conclusions The risk of congenital abnormalities and some birth complications were significantly higher in ART than normal conception, while chromosomal abnormalities were not; therefore, the application of ART should be selected individually for patients by detailed assessment to reduce such risks in the population.
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Affiliation(s)
- Hayedeh Hoorsan
- Department of Nursing and Midwifery, Islamic Azad University Sanandaj Branch, Sanandaj, Iran
| | - Parvin Mirmiran
- Department of Nursing and Midwifery, Islamic Azad University Sanandaj Branch, Sanandaj, Iran
| | - Shahla Chaichian
- Department of Nursing and Midwifery, Islamic Azad University Sanandaj Branch, Sanandaj, Iran
| | - Yousef Moradi
- Department of Nursing and Midwifery, Islamic Azad University Sanandaj Branch, Sanandaj, Iran
| | - Roza Hoorsan
- Department of Nursing and Midwifery, Islamic Azad University Sanandaj Branch, Sanandaj, Iran
| | - Fatemeh Jesmi
- Department of Nursing and Midwifery, Islamic Azad University Sanandaj Branch, Sanandaj, Iran
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Abstract
OBJECTIVE To compare children's cognitive, motor, and language development at 2 years of age after assisted reproductive technologies (ARTs) relative to natural conception. METHODS The 3D-Study (2010-2012) is a prospective cohort study, which sought to improve the understanding among perinatal events, obstetric outcomes, and child development. A total of 2,366 pregnant women were recruited, of whom 278 conceived with ART: ovarian stimulation, intrauterine sperm insemination, in vitro fertilization, intracytoplasmic sperm injection, or in vitro maturation. Natural conception was defined as the unassisted establishment of pregnancy. Cognitive, motor, and language neurodevelopmental outcomes were compared between ART and natural conception groups at 24 months using the Bayley Scales of Infant and Toddler Development, 3rd edition, and the MacArthur-Bates Communicative Development Inventories. Adjusted linear regression models evaluated the effect of ART on neurodevelopmental outcomes using natural conception as a reference. RESULTS A total of 175 children in the ART group (62.9%) and 1,345 children in the natural conception group (64.4%) underwent neurodevelopmental assessment at 24 months postpartum. After adjusting for relevant confounders, children born after ART showed no difference in Bayley scales' cognitive scores (B1 [standard error]=-1.60 [0.9], 95% confidence interval [CI] -3.36 to 0.16), composite motor scores (B1 [standard error]=-1.33 [1.0], 95% CI -3.29 to 0.63), or MacArthur-Bates language scores (B1 [standard error]=-0.28 [2.1], 95% CI -4.39 to 3.83). No difference was observed when independent ART techniques were compared nor when comparing in vivo (ovarian stimulation or intrauterine insemination) or in vitro (in vitro fertilization, intracytoplasmic sperm injection, or in vitro maturation) techniques (P>.05). CONCLUSION Children born after ART had similar cognitive, motor, and language development as children born after natural conception at 2 years of age. These findings may be useful in the clinical counseling of patients undergoing ART.
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Sunde A, Brison D, Dumoulin J, Harper J, Lundin K, Magli MC, Van den Abbeel E, Veiga A. Time to take human embryo culture seriously. Hum Reprod 2016; 31:2174-82. [PMID: 27554442 DOI: 10.1093/humrep/dew157] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
STUDY QUESTION Is it important that end-users know the composition of human embryo culture media? SUMMARY ANSWER We argue that there is as strong case for full transparency concerning the composition of embryo culture media intended for human use. WHAT IS KNOWN ALREADY Published data suggest that the composition of embryo culture media may influence the phenotype of the offspring. STUDY DESIGN, SIZE, DURATION A review of the literature was carried out. PARTICIPANTS/MATERIALS, SETTING, METHODS Data concerning the potential effects on embryo development of culture media were assessed and recommendations for users made. MAIN RESULTS AND THE ROLE OF CHANCE The safety of ART procedures, especially with respect to the health of the offspring, is of major importance. There are reports from the literature indicating a possible effect of culture conditions, including culture media, on embryo and fetal development. Since the introduction of commercially available culture media, there has been a rapid development of different formulations, often not fully documented, disclosed or justified. There is now evidence that the environment the early embryo is exposed to can cause reprogramming of embryonic growth leading to alterations in fetal growth trajectory, birthweight, childhood growth and long-term disease including Type II diabetes and cardiovascular problems. The mechanism for this is likely to be epigenetic changes during the preimplantation period of development. In the present paper the ESHRE working group on culture media summarizes the present knowledge of potential effects on embryo development related to culture media, and makes recommendations. LIMITATIONS, REASONS FOR CAUTION There is still a need for large prospective randomized trials to further elucidate the link between the composition of embryo culture media used and the phenotype of the offspring. We do not presently know if the phenotypic changes induced by in vitro embryo culture represent a problem for long-term health of the offspring. WIDER IMPLICATIONS OF THE FINDINGS Published data indicate that there is a strong case for demanding full transparency concerning the compositions of and the scientific rationale behind the composition of embryo culture media. STUDY FUNDING/COMPETING INTERESTS This work was funded by The European Society for Human Reproduction and Embryology. No competing interests to declare.
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Affiliation(s)
- Arne Sunde
- Department of Obstetrics and Gynaecology, St. Olav's University Hospital in Trondheim, Trondheim, Norway
| | - Daniel Brison
- Department of Reproductive Medicine, St Mary's Hospital, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - John Dumoulin
- Department of Obstetrics and Gynaecology, IVF Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joyce Harper
- Embryology, IVF and reproductive genetics group, Institute for Women's Health, University College London, London, UK
| | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | | | - Anna Veiga
- Reproductive Medicine Service, Hospital Universitari Dexeus, Barcelona, Spain
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Yeung EH, Sundaram R, Bell EM, Druschel C, Kus C, Ghassabian A, Bello S, Xie Y, Buck Louis GM. Examining Infertility Treatment and Early Childhood Development in the Upstate KIDS Study. JAMA Pediatr 2016; 170:251-8. [PMID: 26746435 PMCID: PMC5000851 DOI: 10.1001/jamapediatrics.2015.4164] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE An increasing percentage of births are conceived with assisted reproductive technology (ART) and other infertility treatment. Despite findings that such treatments may be associated with diminished gestation and birth size, scarce data exist regarding infertility treatments and children's development in the United States. OBJECTIVE To assess the use and type of infertility treatment in relation to children's development through age 36 months. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study (conducted 2008-2014) that sampled based on infertility treatment and plurality. Included in the study were infants born between 2008 and 2010 in New York state (excluding New York City) whose parents completed developmental screening instruments through 36 months of age. A total of 4824 mothers (97% of 4989) completed 1 or more developmental screening instruments for 5841 children, including 1830 conceived with infertility treatment and 2074 twins. EXPOSURES Maternal self-report of any infertility treatment was further categorized into ART and ovulation induction/intrauterine insemination. Assisted reproductive technology use was previously validated by linkage with the Society for Assisted Reproductive Technology-Clinical Outcome Reporting System. MAIN OUTCOMES AND MEASURES Five developmental domains (fine motor, gross motor, communication, personal-social functioning, and problem-solving ability), as measured by the parental completion of the Ages and Stages Questionnaires at 4, 8, 12, 18, 24, 30, and 36 months of age. Generalized linear mixed modeling techniques estimated adjusted odds ratios (aORs) and 95% CIs for use and type of infertility treatment in relation to failing a developmental domain. Data were stratified by plurality and weighted for the sampling scheme. RESULTS There were 1422 mothers (29.5%; mean [SD], age, 34.1 [5.2] years) who underwent infertility treatment. Infertility treatment was not associated with risk of their children failing any developmental domain (aOR, 1.33; 95% CI, 0.94-1.89). Assisted reproductive technology was associated with increased risk for failing any developmental domain but only when singletons and twins were evaluated together (aOR, 1.81; 95% CI, 1.21-2.72). Adjustment for birth weight further attenuated this estimate (aOR, 1.26; 95% CI, 0.82-1.93). After stratifying by plurality, type of treatment also was not significantly associated with failing any developmental domain for ovulation induction/intrauterine insemination (aOR, 1.00; 95% CI, 0.57-1.77 for singletons and aOR, 1.30; 95% CI, 0.76-2.21 for twins) or ART (aOR, 1.38; 95% CI, 0.78-2.43 for singletons and aOR, 1.58; 95% CI, 0.94-2.65 for twins). CONCLUSIONS AND RELEVANCE After considering plurality, children's development through age 3 years was similar irrespective of infertility treatment or specific type. To our knowledge, these findings are among the first to focus on non-ART treatments in the United States.
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Affiliation(s)
- Edwina H. Yeung
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Rajeshwari Sundaram
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Erin M. Bell
- Department of Environmental Health Sciences, University at Albany School of Public Health, Albany, New York3Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, New York
| | - Charlotte Druschel
- Department of Environmental Health Sciences, University at Albany School of Public Health, Albany, New York4Bureau of Environmental and Occupational Epidemiology, Center for Environmental Health, New York State Department of Health, Albany
| | - Christopher Kus
- Division of Family Health, New York State Department of Health, Albany
| | - Akhgar Ghassabian
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Scott Bello
- Developmental Pediatrics, CapitalCare Pediatrics–Troy, Troy, New York
| | - Yunlong Xie
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Germaine M. Buck Louis
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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Buck Louis GM, Hediger ML, Bell EM, Kus CA, Sundaram R, McLain AC, Yeung E, Hills EA, Thoma ME, Druschel CM. Methodology for establishing a population-based birth cohort focusing on couple fertility and children's development, the Upstate KIDS Study. Paediatr Perinat Epidemiol 2014; 28:191-202. [PMID: 24665916 PMCID: PMC4563277 DOI: 10.1111/ppe.12121] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Critical data gaps remain regarding infertility treatment and child development. We assessed the utility of a birth certificate registry for developing a population cohort aimed at answering such questions. METHODS We utilised the Upstate New York livebirth registry (n = 201,063) to select births conceived with (n = 4024) infertility treatment or exposed infants, who were then frequency-matched by residence to a random sample of infants conceived without (n = 14,455) treatment or unexposed infants, 2008-10. Mothers were recruited at 2-4 months postpartum and queried about their reproductive histories, including infertility treatment for comparison with birth certificate data. Overall, 1297 (32%) mothers of exposed and 3692 of unexposed (26%) infants enrolled. RESULTS Twins represented 22% of each infant group. The percentage of infants conceived with/without infertility treatment was similar whether derived from the birth registry or maternal report: 71% none, 16% drugs or intrauterine insemination, and 14% assisted reproductive technologies (ART). Concordant reporting between the two data sources was 93% for no treatment, 88% for ART, and 83% for fertility drugs, but differed by plurality. Exposed infants had slightly (P < 0.01) earlier gestations than unexposed infants (38.3 ± 2.8 and 38.7 ± 2.7 weeks, respectively) based upon birth certificates but not maternal report (38.7 ± 2.7 and 38.7 ± 2.9, respectively). Conversely, mean birthweight was comparable using birth certificates (3157 ± 704 and 3194 ± 679 g, respectively), but differed using maternal report (3167 ± 692 and 3224 ± 661, respectively P < 0.05). CONCLUSIONS The birth certificate registry is a suitable sampling framework as measured by concordance with maternally reported infertility treatment. Future efforts should address the impact of factors associated with discordant reporting on research findings.
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Affiliation(s)
- Germaine M. Buck Louis
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development, 6100 Executive Blvd., Room 7B03, Rockville, MD 20852
| | - Mary L. Hediger
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development, 6100 Executive Blvd., Room 7B03, Rockville, MD 20852
| | - Erin M. Bell
- Department of Environmental Health Sciences, University at Albany School of Public Health, Albany, NY
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, NY
| | - Christopher A. Kus
- Division of Family Health, New York State Department of Health, Albany, NY
| | - Rajeshwari Sundaram
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development, 6100 Executive Blvd., Room 7B03, Rockville, MD 20852
| | - Alexander C. McLain
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina at Columbia
| | - Edwina Yeung
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development, 6100 Executive Blvd., Room 7B03, Rockville, MD 20852
| | - Elaine A. Hills
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, NY
- Congenital Malformations Registry, New York State Department of Health, Albany, NY
| | - Marie E. Thoma
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development, 6100 Executive Blvd., Room 7B03, Rockville, MD 20852
| | - Charlotte M. Druschel
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, NY
- Congenital Malformations Registry, New York State Department of Health, Albany, NY
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Conti E, Mazzotti S, Calderoni S, Saviozzi I, Guzzetta A. Are children born after assisted reproductive technology at increased risk of autism spectrum disorders? A systematic review. Hum Reprod 2013; 28:3316-27. [PMID: 24129612 DOI: 10.1093/humrep/det380] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
STUDY QUESTION Are children born after assisted reproductive technology (ART) at increased risk of autism spectrum disorders (ASD)? SUMMARY ANSWER There is no evidence that ART significantly increases the risk of ASD in the offspring. WHAT IS KNOWN ALREADY A few systematic reviews have explored the correlation between assisted conception and ASD with inconclusive results, partly due to the heterogeneity of diagnostic criteria and methodology in the different studies. STUDY DESIGN, SIZE, DURATION Systematic review of 7 observational studies (2 cohort and 5 case-control) encompassing 9216 subjects diagnosed with ASD published since 2000. MATERIALS, SETTING, METHODS Literature searches were conducted to retrieve observational studies on the risk of ASD in ART population. Databases searched included PubMed, EMBASE and PsycINFO. In order to obtain more consistent results, we only included the studies in which (i) subjects with either infantile autism or ASD could be identified according to international classification systems and (ii) the diagnosis was obtained from hospital records. Seven studies matched the inclusion criteria. MAIN RESULTS AND THE ROLE OF CHANCE Four out of seven studies, including the two with the best quality scores, did not show an association between ART and ASD. The two papers supporting an increased risk of autism following ART had the lowest quality scores, due to major methodological limitations. Only one paper showed a protective role of ART. LIMITATIONS, REASONS FOR CAUTION In spite of the strict inclusion criteria applied as to the diagnosis of ASD, the papers selected are heterogeneous in many aspects including study design, definitions of ART, data source and analysed confounders. WIDER IMPLICATIONS OF THE FINDINGS At present, there is no evidence that ART is significantly associated with ASD and hence that current health policies should be modified. The divergent results of some of the studies suggest that further prospective, large and high-quality studies are still needed. STUDY FUNDING/COMPETING INTEREST(S) This work was supported, in part, by the Italian Ministry of Health and by Tuscany Region. The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- E Conti
- Department of Developmental Neuroscience, IRCCS Stella Maris, Via dei Giacinti 2, 56128 Calambrone, Pisa, Italy
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Barnhart KT. Assisted reproductive technologies and perinatal morbidity: interrogating the association. Fertil Steril 2013; 99:299-302. [PMID: 23375143 PMCID: PMC3564059 DOI: 10.1016/j.fertnstert.2012.12.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 12/20/2012] [Indexed: 11/27/2022]
Abstract
Interrogating the association between assisted reproductive technologies (ART) and perinatal outcome is complicated but very important. This is an introduction to a series of articles that review this potential association with an eye toward etiology of risk, and what aspects of in vitro fertilization (IVF) can be modified to reduce this risk. When an association is not due to chance (i.e., statistically significant), one must also consider how the association may be affected due to bias or confounding. Despite lack of the perfect study, perinatal consequences of ART are apparent, even though the vast majority of children conceived with ART are healthy. Pregnancy after IVF is altered as evidenced by risk of preterm delivery, low birth weight among infants, and an alerted prevalence of preeclampsia. The long-term clinical implications of ART, such as childhood development and metabolism, have not been established and ongoing study is proceeding. The risk attributed to multiple births is iatrogenic and needs to be minimized. Optimizing the environment at the time a woman conceives will likely have an effect on gestation as well as the health of children. Reproduction effects health and health effects reproduction.
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Affiliation(s)
- Kurt T Barnhart
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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