Assisted Reproduction and Child Health: Risk of Birth Defects, Mortality, and Effect on Grade School Performance

辅助生殖和儿童健康：出生缺陷、死亡率的风险以及对小学成绩的影响

• 批准号: 9152497
• 负责人: BARBARA Joan LUKE
• 金额: $ 59.97万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-30 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9152497
• 关键词: Accounting; Admission activity; Affect; Age; Age-Years; Artificial Insemination; Assisted Reproductive Technology; Biology; Birth; Birth Certificates; Caring; Cessation of life; Characteristics; Child; Child health care; Conceptions; Congenital Abnormality; Control Groups; Couples; Data; Fertilization in Vitro; First Births; Growth; Hospital Costs; Infant; Infant Mortality; Infertility; Intracytoplasmic Sperm Injections; Knowledge; Link; Live Birth; Malignant Childhood Neoplasm; Massachusetts; Maternal Age; Maternal Educational Status; Medical; Methods; New York; North Carolina; Oocytes; Outcome; Ovulation Induction; Pediatric Hospitals; Performance; Process; Quadruplet Multiple Birth; Registries; Reporting; Risk; Sample Size; Sampling; Schools; Seminal fluid; Services; Siblings; Small for Gestational Age Infant; Societies; Special Education; Surveillance Methods; Testing; Texas; Treatment Factor; Triplet Multiple Birth; Twin Multiple Birth; United States; Woman; adverse outcome; assisted reproduction; base; elementary school; follow-up; high risk; improved; infertility treatment; intrauterine insemination; mental development; mortality; neoplasm registry; population based; premature; reproductive; technology/technique

It is estimated that about 12% of reproductive age women in the United States have ever sought medical care for infertility. Assisted reproductive technology (ART) includes all infertility treatments to achieve conception; in vitro fertilization (IVF) is the process by which an oocyte is fertilized by semen outside the body; non-IVF ART treatments include ovulation induction, artificial insemination, and intrauterine insemination. In 2013 in the United States, there were nearly 68,000 babies born from IVF, accounting for 1.7% of all births, a proportion which has doubled over the past decade. To date, there has not been a population-based study of ART and IVF in the United States linking data on ART treatments, birth outcomes, registry-confirmed birth defects, and school performance. With this proposed study we seek to fill this knowledge gap. The purpose of this study is to evaluate the risk of mortality, birth defects, and effect on grade school performance among children conceived through IVF and ART, their siblings, and controls in New York, Texas, Massachusetts, and North Carolina. This proposed study will be based on births from 2004-18, and will include an estimated 163,000 IVF children, 41,000 IVF siblings, and 1,250,000 non-IVF control children. Overall Specific Aim: To compare the rates of birth defects and mortality, and effect on school performance among children conceived with IVF, non-IVF ART, and spontaneously, including siblings. Hypothesis 1: Children born from IVF have higher risks for birth defects than the control group; the risk varies by treatments and parental characteristics. Primary Aims:1) To test whether the risk of birth defects in IVF and non-IVF ART births are higher than in spontaneously-conceived births; 2) To identify parental factors affecting risk within each group; 3) In the IVF group, to identify treatment factors that affect the risk. Hypothesis 2: Children born from IVF have higher risks of death compared to their siblings and non-IVF Control children, primarily due to plurality status (greater likelihood of being conceived as a twin, triplet, or quadruplet, but born as a singleton; or of having been born a twin, triplet, or quadruplet) and associated excess of growth restriction (small-for-gestational age) and prematurity. This greater perinatally-related mortality risk is hypothesized to be nonsignificant by two years of age, and varies by infertility treatments and parental factors (particularly reduced with older maternal age at delivery and higher maternal educational status). Hypothesis 3: Children born from IVF have greater risks of poorer educational performance and are more likely to need special education services compared to their siblings and non-IVF Control children, primarily due to their plurality status (greater likelihood of being conceived as a twin, triplet, or quadruplet, but born as a singleton; or of having been born a twin, triplet, or quadruplet) and the associated excess of growth restriction (small-for-gestational age) and prematurity. This greater perinatally-related educational risk varies by infertility treatments and parental factors (particularly reduced with older maternal age at delivery and higher maternal educational status).

据估计，美国约 12% 的育龄妇女曾寻求过医疗护理 对于不孕症。辅助生殖技术（ART）包括所有旨在实现受孕的不孕不育治疗；在 体外受精（IVF）是指在体外通过精液使卵母细胞受精的过程；非IVF ART 治疗包括诱导排卵、人工授精和宫内授精。 2013年在 美国，有近68,000名通过试管婴儿出生的婴儿，占所有出生婴儿的1.7%，比例 过去十年翻了一番。迄今为止，还没有针对 ART 进行基于人群的研究 美国的 IVF 将 ART 治疗、出生结果、登记确认的出生缺陷等数据联系起来 学校表现。通过这项拟议的研究，我们试图填补这一知识空白。本研究的目的是 评估儿童死亡、出生缺陷的风险以及对小学成绩的影响 通过 IVF 和 ART 受孕，他们的兄弟姐妹，以及纽约州、德克萨斯州、马萨诸塞州和北部的对照 卡罗莱纳.这项拟议的研究将基于 2004-18 年的出生情况，并将包括估计 163,000 名 IVF 患者 儿童、41,000 名 IVF 兄弟姐妹和 1,250,000 名非 IVF 对照儿童。总体具体目标：比较 通过 IVF 受孕的儿童的出生缺陷率和死亡率以及对学校表现的影响， 非 IVF ART，自发的，包括兄弟姐妹。假设1：IVF出生的孩子风险更高 出生缺陷率高于对照组；风险因治疗方法和父母特征而异。基本的 目的：1) 测试IVF和非IVF ART出生的出生缺陷风险是否高于ART出生 自然受孕； 2) 确定影响每组风险的父母因素； 3）在试管婴儿中 小组，以确定影响风险的治疗因素。假设2：IVF出生的孩子有更高的 与兄弟姐妹和非 IVF 对照儿童相比，死亡风险主要是由于多重身份 （怀为双胞胎、三胞胎或四胞胎但出生时为单胞胎的可能性更大；或者 出生为双胞胎、三胞胎或四胞胎）以及相关的过度生长限制（小于胎龄） 和早产。假设这种更大的围产期相关死亡风险不显着 年龄，并因不孕治疗和父母因素而异（特别是年龄较大的母亲会减少） 分娩年龄和母亲受教育程度较高）。假设3：IVF 出生的孩子有更大的 与其他人相比，他们有教育表现较差的风险，并且更有可能需要特殊教育服务 他们的兄弟姐妹和非 IVF 控制儿童，主要是由于他们的多重身份（更有可能成为 怀为双胞胎、三胞胎或四胞胎，但出生时为单胞胎；或出生为双胞胎、三胞胎或 四胞胎）以及相关的过度生长限制（小于胎龄）和早产。这 更大的围产期相关教育风险因不孕症治疗和父母因素（特别是 随着产妇分娩年龄的增加和产妇教育程度的提高而降低）。