医学的支援生殖により生まれた子供の高い長期医療利用：16年間のコホート研究からの所見

The use of medically assisted reproduction is increasing over time and there is limited evidence surrounding the long-term health services utilization associated with medically assisted reproduction.

To examine long-term healthcare service utilization and prescription medication use in children conceived with medically assisted reproduction compared to naturally conceived children.

Data from the Growing up in Australia: Longitudinal Study of Australian Children, a population-based longitudinal cohort study, linked with Australian Medicare administrative records, were used for this study. Out-of-hospital healthcare service utilization and costs, including prescription medication use, were compared between children conceived with and without medically assisted reproduction. Generalized linear models and logistic models were applied to investigate the association of medically assisted reproduction and total health costs and use of prescription medications, respectively, adjusting for a wide range of birth, pregnancy conditions and socioeconomic characteristics.

The study includes 4,789 singleton children followed from birth to age 16, with 246 conceived with medically assisted reproduction. Higher healthcare utilization and costs were seen for medically assisted reproduction conceived versus naturally conceived children across all age bands except for ages 10-11, and the differences were statistically significant for ages 2-3 (Mean difference $87.53, 95%CI: $8.87-$166.19) and age 4-5 (Mean difference $117.53, 95%CI: $30.95-$204.11) after controlling for birth, pregnancy conditions and socioeconomic characteristics. For all available age bands, ages 6-15, medically assisted reproduction conceived children were found to have 2.41 (95%CI: 1.15-5.08) to 3.20 (95%CI: 1.54-6.64) times the odds of being prescribed attention-deficit/hyperactivity disorder medications compared to naturally conceived children after controlling for birth, pregnancy conditions and socioeconomic characteristics. For mental health medications, medically assisted reproduction conceived children had 5.24 (95%CI: 2.02-13.58) and 2.96 (95%CI:1.23-7.13) times the odds of being prescribed these medications compared to naturally conceived children for age bands 4-5 and 6-7, respectively, after adjusting for covariates. Little to no differences were observed between medically assisted reproduction conceived children and naturally conceived children for the use of prescription of adrenaline autoinjectors, asthma medications, eczema medications, anti-infectives (anti-viral, anti-bacterial, anti-fungal), or other medications.

This study highlights a higher need for long-term healthcare services and associated resources for medically assisted reproduction conceived children, which can't be explained by socioeconomic-related parental health-seeking behaviors and perinatal factors like multiple birth and birth weight. This helps anticipate the downstream financial impact for the health system associated with the increasing use of medically assisted reproduction, and emphasises an opportunity for early screening and detection of relevant health conditions among children conceived with medically assisted reproduction.