Various techniques in assisted reproductive technology (ART) have been developed as solutions for specific infertility problems. It is important to gain consensual conclusions on the actual risks of neurodevelopmental disorders among children who are born from ART. This study aimed to quantify the relative risks of cerebral palsy, intellectual disability, autism spectrum disorder (ASD), and behavioral problems in children from different ART methods by using systematic review and meta-analysis. Healthcare providers could use the results of this study to suggest the suitable ART technique and plan optimum postnatal care. Pubmed, Google Scholar, and Scopus databases were used to search for studies up to January 2020. Of the 181 screened full manuscripts, 17 studies (9.39%) fulfilled the selection criteria. Based on the Newcastle-Ottawa scale ratings, 7 studies were excluded, resulting in 10 studies that were eventually included in the meta-analyses. Mantel-Haenszel risk ratio model was used in the meta-analysis, and the results are described using forest plot with 95% confidence interval. Heterogeneity was assessed using the I2 value. Pooled evaluation of 10 studies showed that the risk of cerebral palsy in children from assisted reproductive technology (ART) is higher than children from natural conceptions (risk ratio [RR] 1.82, [1.41, 2.34]; P = 0.00001). Risk of intellectual disability (RR 1.46, [1.03, 2.08]; P = 0.03) and ASD (RR 1.49 [1.05, 2.11]; P = 0.03) are higher in intracytoplasmic sperm injection (ICSI) children compared to conventional in vitro fertilization (IVF) children. The differences in the risk of neurodevelopmental disorders in children born after frozen and fresh embryo transfers are not significant. Analysis on potential cofounder effects, including multiple birth, preterm birth, and low birth body weight highlight possibilities of significant correlation to the risks of neurodevelopmental disorders. Pooled estimates suggest that children born after ART are at higher risk of acquiring cerebral palsy. ICSI treatment causes higher risk of intellectual disability and ASD. These findings suggest the importance of the availability of intensive care unit at the time of delivery and long-term developmental evaluation particularly in children from ICSI.

中文翻译：

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不同 ART 治疗所生儿童的神经发育障碍风险：系统评价和荟萃分析

辅助生殖技术 (ART) 中的各种技术已被开发为特定不孕症问题的解决方案。重要的是要就 ART 出生的儿童神经发育障碍的实际风险达成共识。本研究旨在通过系统评价和荟萃分析，量化使用不同 ART 方法的儿童脑瘫、智力障碍、自闭症谱系障碍 (ASD) 和行为问题的相对风险。医疗保健提供者可以使用这项研究的结果来建议合适的 ART 技术并计划最佳的产后护理。使用 Pubmed、Google Scholar 和 Scopus 数据库搜索截至 2020 年 1 月的研究。在筛选的 181 篇完整手稿中，17 篇研究 (9.39%) 符合选择标准。根据纽卡斯尔-渥太华量表评级，7 项研究被排除在外，导致 10 项研究最终被纳入荟萃分析。荟萃分析中使用了 Mantel-Haenszel 风险比模型，并使用具有 95% 置信区间的森林图描述了结果。使用 I2 值评估异质性。对 10 项研究的汇总评估表明，辅助生殖技术 (ART) 儿童患脑瘫的风险高于自然受孕儿童（风险比 [RR] 1.82、[1.41、2.34]；P = 0.00001）。与传统的体外受精相比，卵胞浆内单精子注射 (ICSI) 儿童智力残疾 (RR 1.46, [1.03, 2.08]; P = 0.03) 和 ASD (RR 1.49 [1.05, 2.11]; P = 0.03) 的风险更高（试管婴儿）儿童。冷冻和新鲜胚胎移植后出生的儿童神经发育障碍风险的差异并不显着。对包括多胞胎、早产和低出生体重在内的潜在共同影响因素的分析强调了与神经发育障碍风险显着相关的可能性。汇总估计表明，ART 后出生的儿童患脑瘫的风险更高。ICSI 治疗导致智力残疾和 ASD 的风险更高。这些研究结果表明，在分娩时提供重症监护病房和长期发育评估的重要性，尤其是对 ICSI 儿童而言。和低出生体重突出了与神经发育障碍风险显着相关的可能性。汇总估计表明，ART 后出生的儿童患脑瘫的风险更高。ICSI 治疗导致智力残疾和 ASD 的风险更高。这些研究结果表明，在分娩时提供重症监护病房和长期发育评估的重要性，尤其是对 ICSI 儿童而言。和低出生体重突出了与神经发育障碍风险显着相关的可能性。汇总估计表明，ART 后出生的儿童患脑瘫的风险更高。ICSI 治疗导致智力残疾和 ASD 的风险更高。这些研究结果表明，在分娩时提供重症监护病房和长期发育评估的重要性，尤其是对 ICSI 儿童而言。