STUDY QUESTION Do publicly funded fertility treatment and single embryo transfer (SET) result in lower hospitalization rates of children of parents with infertility? SUMMARY ANSWER Following the 2010 Quebec law introducing free fertility treatment and SET, neonatal intensive care unit (NICU) admissions decreased among all children born to parents with infertility, but not among singletons, whose risk remained slightly higher than that of children of parents without infertility, even accounting for treatment and maternal age. WHAT IS KNOWN ALREADY Previous studies reported lower NICU admission rates among children conceived with ART after the 2010 law; however, children conceived without ART by parents with infertility were not considered. STUDY DESIGN, SIZE, DURATION Cohort study of children born in 1997–2017 to patients evaluated for infertility (‘exposed’) at an academic fertility center in Montreal (Canada) in 1996–2015. A random sample of births to Montreal residents served as comparison. Outcomes were identified from Quebec administrative databases. PARTICIPANTS/MATERIALS, SETTING, METHODS We compared children’s healthcare utilization before and after the 2010 law in 6273 exposed and 12 583 randomly sampled births (6846 and 12 775 children, respectively). We repeated the analysis among children conceived in the 63 months before and after the law (‘restricted period’), and examined whether differences in twinning, fertility treatment, and maternal age explained the higher risk of NICU admission among children of parents with infertility. MAIN RESULTS AND THE ROLE OF CHANCE In the exposed cohort, the proportion of twin births and of several adverse outcomes declined after the law. NICU admission and duration of NICU stay decreased overall, but not in singletons. Both measures remained higher in exposed children. Except for NICU admission, hospitalization rates were similar in exposed and random sample children. After accounting for fertility treatment and maternal age, exposed singletons were 17% more likely to be admitted to the NICU than children of parents with no medical history of infertility. LIMITATIONS, REASONS FOR CAUTION Sample size was relatively small; infertile patients were from a single center and the random sample from one city. Despite some limitations, administrative databases are likely to accurately reflect healthcare utilization. WIDER IMPLICATIONS OF THE FINDINGS Universal access to treatment and, particularly, SET results in an overall reduction of adverse outcomes among children conceived with treatment; however, children of parents with infertility are at a slightly higher risk, regardless of treatment. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Canadian Institutes for Health Research (CIHR, grant no. 123362). No competing interests. TRIAL REGISTRATION NUMBER N/A.

中文翻译：

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医学辅助生殖监管对生命头2年住院风险的影响

研究问题 公共资助的生育治疗和单胚胎移植 (SET) 是否会降低不育父母子女的住院率？总结答案 继 2010 年魁北克法律引入免费生育治疗和 SET 后，新生儿重症监护病房 (NICU) 入院率在所有患有不孕症的父母所生的孩子中有所下降，但在单身人士中没有下降，其风险仍然略高于父母没有不孕症的孩子，甚至考虑到治疗和产妇年龄。已知情况 先前的研究报告称，在 2010 年法律颁布后，接受 ART 怀孕的儿童的 NICU 入院率较低；然而，不考虑由不孕症父母在未接受抗逆转录病毒治疗的情况下怀孕的孩子。研究设计，尺寸，持续时间 1997-2017 年出生的儿童与 1996-2015 年在蒙特利尔（加拿大）的学术生育中心评估为不孕症（“暴露”）的患者进行的队列研究。蒙特利尔居民的随机出生样本作为比较。结果是从魁北克行政数据库中确定的。参与者/材料、设置、方法 我们比较了 2010 年法律实施前后 6273 名暴露和 12583 名随机抽样出生的儿童（分别为 6846 名和 12775 名儿童）的儿童医疗保健利用情况。我们对法律前后 63 个月（“限制期”）内受孕的孩子重复分析，并检查双胞胎、生育治疗和母亲年龄的差异是否解释了父母有不育症的孩子入住 NICU 的风险较高。主要结果和机会的作用 在暴露的队列中，法律颁布后，双胞胎出生的比例和一些不良后果的比例有所下降。新生儿重症监护病房入院和新生儿重症监护病房住院时间总体下降，但单身人士没有。这两项措施在暴露儿童中仍然较高。除 NICU 入院外，暴露儿童和随机样本儿童的住院率相似。在考虑生育治疗和母亲年龄后，与没有不孕症病史的父母的孩子相比，暴露在新生儿重症监护室的单胞胎的可能性要高出 17%。局限性、谨慎的原因 样本量相对较小；不孕症患者来自一个中心，随机样本来自一个城市。尽管存在一些限制，但管理数据库可能会准确反映医疗保健的使用情况。研究结果的更广泛意义 普遍获得治疗，特别是，SET 导致接受治疗的儿童的不良结局总体减少；然而，无论接受何种治疗，父母患有不孕症的孩子的风险都略高。研究资助/竞争利益 本研究由加拿大卫生研究院 (CIHR, 授权号 123362) 资助。没有竞争利益。试用注册号 不适用。