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Published on: March 28, 2018
Mortality from infancy to adolescence in singleton children conceived from assisted reproductive techniques
Kenny A Rodriguez-Wallberg1, Frida E Lundberg2, Sara Ekberg3
1Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden.
Insights
Infants conceived via assisted reproductive techniques (ART) face a higher risk of mortality within their first year, particularly in the early neonatal period. This increased risk is notably linked to frozen embryo transfers, but no elevated risk is seen in childhood.
Area of Science:
- Reproductive Medicine
- Perinatal Epidemiology
- Public Health
Background:
- Assisted reproductive techniques (ART) have become widespread globally.
- Understanding the long-term health outcomes for children conceived via ART is crucial.
- Previous studies have yielded conflicting results regarding infant mortality after ART conception.
Purpose of the Study:
- To evaluate and compare infant and childhood mortality rates in singletons conceived through ART versus natural conception.
- To identify specific ART procedures associated with increased mortality risks.
Main Methods:
- A nationwide prospective cohort study in Sweden (1983-2012) included over 2.8 million singleton liveborn infants.
- Data were sourced from the Medical Birth Register, linking ART treatments to mortality outcomes.
- Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) for mortality, controlling for covariates.
Main Results:
- Infants conceived via ART showed a significantly higher risk of infant mortality (adjusted HR 1.45) compared to naturally conceived infants.
- The risk was particularly elevated following the transfer of cryopreserved embryos (adjusted HR 2.30).
- Early neonatal mortality risk was increased after blastocyst transfer (HR 2.40), but no increased mortality was observed between ages 1 and 18 years.
Conclusions:
- Singletons conceived via ART have an increased risk of infant mortality, primarily in the early neonatal period.
- Frozen and thawed embryo transfers are associated with a more pronounced increase in infant mortality risk.
- ART conception does not appear to increase mortality risk during childhood (1-18 years).
Objective:
To assess infant (<1 year) and childhood (1-18 years) mortality in singletons conceived through assisted reproductive techniques (ART) versus naturally conceived singletons.
Design:
Nationwide prospective study.
Setting:
Sweden.
Patient(S):
All singleton liveborn infants born from 1983 to 2012 in Sweden identified using the Medical Birth Register (N = 2,847,108), of whom 43,506 were conceived through ART treatments including in vitro fertilization with and without intracytoplasmic sperm injection.
Intervention(S):
None.
Main Outcome Measures(S):
Infant (<1 year) and childhood (1-18 years) mortality.
Result(S):
Data on ART treatment and covariates were retrieved from population-based registers using the unique personal identity number assigned to all permanent residents in Sweden. Cox proportional hazards models estimated the hazard ratios (HRs) with 95% confidence intervals (CIs) as measures of association between ART treatments and death. The analyses were adjusted for maternal characteristics, infertility, child sex, and birth cohort and were restricted to individuals with complete information on covariates for fully adjusted analysis. Compared with naturally conceived singletons, higher infant mortality risks were seen in infants conceived through ART (adjusted HR 1.45; 95% CI, 1.19-1.77), especially after transfer of cryopreserved embryos (adjusted HR 2.30; 95% CI, 1.46-3.64). Early neonatal mortality risk (deaths during the first week) was increased in children born after transfer of blastocysts (HR 2.40; 95% CI, 1.05-5.48). No increased mortality risk was observed between the ages of 1 and 18 years.
Conclusion(S):
Singletons conceived through ART had an increased risk of infant mortality from birth up to 1 year of life, predominantly in the early neonatal period and in pregnancies after transfer of frozen and thawed embryos.
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