在体外受精后出生的后代中出现自闭症和精神障碍
Sven Sandin1, Karl-Gösta Nygren, Anastasia Iliadou
1Department of Psychosis Studies, Institute of Psychiatry, King's College London, England. sven.sandin@kcl.ac.uk
JAMA
|July 4, 2013
概括
在体外受精 (IVF) 整体上与自闭症无关,但显示精神障碍风险略有增加. 特定的试管婴儿程序,特别是细胞内质精子注射 (ICSI),可能会增加这两种情况的风险.
科学领域:
- 生殖医学 生殖医学
- 发育神经科学的发展神经科学.
- 公共卫生 公共卫生
背景情况:
- 数以百万计的婴儿通过体外受精 (IVF) 出生,但神经发育结果,特别是婴儿期以外的结果,需要进一步调查.
- 关于与各种辅助生殖技术相关的长期神经发育风险的数据有限.
研究的目的:
- 评估任何试管婴儿和特定试管婴儿程序与后代自闭症障碍和精神障碍风险之间的关联.
- 为了比较不同IVF技术之间的风险,包括细胞体内精子注射 (ICSI) 和胚胎移植方法.
主要方法:
- 一项基于人口的前性队列研究,利用瑞典国家卫生登记册.
- 对1982年至2007年间出生后代进行自闭症障碍或精神障碍诊断的随访.
- 基于ICSI使用 (排泄与手术提取精子) 和胚胎状态 (新鲜与冷) 的IVF暴露的分类.
主要成果:
- 总体而言,试管婴儿与自闭症症并没有显著的关联,但在精神障碍风险上显示出小而显著的增加 (RR 1.18).
- 与没有ICSI的试管婴儿相比,细胞体内精子注射 (ICSI),特别是用手术提取的精子,与自闭症障碍和精神障碍的风险显著增加.
- 当仅分析单子时,与ICSI相关的风险增加对于自闭症障碍变得无关紧要,但对于冷胚胎的智力障碍仍然很重要.
结论:
- 虽然整体而言,试管婴儿对神经发育障碍的风险很小,但像ICSI这样的特定程序需要进一步关注.
- 与试管婴儿相关的自闭症障碍和精神障碍的绝对风险增加仍然很低.
- 需要进一步的研究,以阐明某些试管婴儿程序与神经发育结果之间观察到的关联背后的具体机制.
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