Background

Assisted reproductive technology use is increasing annually; however, data on long-term child health outcomes including hospital admissions are limited.

Objective

This study aimed to examine the potential effects of assisted reproductive technology on any and cause-specific hospital admissions unrelated to perinatal diagnoses.

Study Design

This was a population-based record-linkage study that included a previously established cohort of children born after assisted reproductive technology in the United Kingdom between 1997 and 2009 (n=63,877), their naturally conceived siblings (n=11,343), and matched naturally conceived population controls (n=127,544) linked to their postnatal health outcomes up to March 31, 2016 to provide robust risk estimates of the potential effects of assisted reproductive technology on any and cause-specific hospital admissions unrelated to perinatal diagnoses. In addition, comparison of hospital admissions by type of treatment was made. Cox regression was used to estimate the risk of hospital admission, and negative binomial regression was used to compare the number of hospital admissions per year.

Results

This study had 1.6 million person-years of follow-up (mean, 12.9 years; range, 0–19 years), and the mean age at the time of first hospital admission was 6.5 years (range, 0–19 years). Singletons born after assisted reproductive technology had increased risk of any hospital admission compared with naturally conceived population controls (hazard ratio, 1.08; 95% confidence interval, 1.05–1.10) but not naturally conceived siblings (hazard ratio, 1.01; 95% confidence interval, 0.94–1.09). We observed increased risk of diagnoses related to neoplasms and diseases of the respiratory, musculoskeletal, digestive, and genitourinary systems, and lower risk of injury, poisoning, and consequences of external causes compared with naturally conceived population controls. Children born after intracytoplasmic sperm injection had a lower risk of hospital admission compared with those born after in vitro fertilization, although no such differences were observed between children born after fresh embryo transfers and those born after frozen embryo transfers.

Conclusion

Children born after assisted reproductive technology had greater numbers of hospital admissions compared with naturally conceived population controls. Attenuation of these differences in relation to their naturally conceived siblings suggested that this could be partially attributed to the influence of parental subfertility on child health, increased parental concerns, and an actual increase in morbidity in children born after assisted conception.

中文翻译：

---

英国辅助生殖技术后受孕儿童队列的总体健康状况：一项基于人群的记录关联研究

 背景

辅助生殖技术的使用逐年增加；然而，有关长期儿童健康结果（包括住院情况）的数据有限。

 客观的

本研究旨在探讨辅助生殖技术对与围产期诊断无关的任何特定原因入院的潜在影响。

 研究设计

这是一项基于人群的记录关联研究，其中包括先前建立的 1997 年至 2009 年间在英国通过辅助生殖技术出生的儿童队列 (n=63,877)、他们自然受孕的兄弟姐妹 (n=11,343) 以及自然匹配的截至 2016 年 3 月 31 日，受孕人口控制（n=127,544）与其产后健康结果相关，以提供辅助生殖技术对与围产期诊断无关的任何特定原因入院的潜在影响的可靠风险评估。此外，还按治疗类型对入院情况进行了比较。 Cox回归用于估计入院风险，负二项回归用于比较每年入院人数。

 结果

该研究进行了 160 万人年的随访（平均 12.9 年；范围：0-19 岁），首次入院时的平均年龄为 6.5 岁（范围：0-19 岁）。与自然受孕的人群对照相比，辅助生殖技术出生的单胎住院风险增加（风险比，1.08；95%置信区间，1.05-1.10），但自然受孕的兄弟姐妹则没有增加（风险比，1.01；95%置信区间， 0.94–1.09）。我们观察到，与自然受孕的人群对照相比，与肿瘤和呼吸系统、肌肉骨骼系统、消化系统和泌尿生殖系统疾病相关的诊断风险增加，受伤、中毒和外因后果的风险降低。与体外受精后出生的儿童相比，胞浆内单精子注射后出生的儿童入院风险较低，但新鲜胚胎移植后出生的儿童与冷冻胚胎移植后出生的儿童之间没有观察到这种差异。

 结论

与自然受孕的人口对照相比，辅助生殖技术出生的儿童住院治疗的人数更多。这些差异相对于自然受孕的兄弟姐妹的减弱表明，这可能部分归因于父母生育力低下对儿童健康的影响、父母担忧的增加以及辅助受孕后出生的儿童发病率的实际增加。