儿童的不孕症和自闭症谱系障碍的风险
Maria P Velez1,2, Natalie Dayan3,4, Jonas Shellenberger2
1Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada.
JAMA network open
|November 20, 2023
概括
通过不育治疗或由于不育而受孕的儿童患自闭症谱系障碍 (ASD) 风险略有增加. 产科和新生儿因素部分解释了这种关联,突出了干预的领域.
科学领域:
- 生殖医学 生殖医学
- 发育儿科 发育儿科
- 流行病学 流行病学
背景情况:
- 之前关于自闭症谱系障碍 (ASD) 风险和生育治疗的研究没有完全考虑不孕本身或介导产科/新生儿因素.
- 了解受孕方法,不孕症和自闭症风险之间的相互作用对于儿童神经发育结果至关重要.
研究的目的:
- 评估不孕不育及其治疗与ASD风险之间的关联.
- 评估不良妊娠结果对不孕症-ASD关联的调解效应.
主要方法:
- 基于人口的队列研究在加拿大安大略省 (2006-2018).
- 包括单胎和多胎活产 (n=1,370,152) 在内.
- 通过使用考克斯回归和调解分析,在各种受孕方式中比较ASD风险:无辅助,不经治疗的不孕 (次孕),排卵诱导/子宫内授精 (OI/IUI) 和体外受精/细胞内精子注射 (IVF/ICSI).
主要成果:
- 低生育率,OI/IUI和IVF/ICSI与非辅助怀孕相比,ASD风险略高 (调整后的HR分别为1.20,1.21,1.16).
- 产科和新生儿因素 (孕前,剖腹产,多胎妊娠,早产,严重的新生儿发病率) 在受孕方法和ASD风险之间的关联中占有很大比例.
- 在IVF/ICSI中,调解比例为:剖腹产 (29%),多胎妊娠 (78%),早产 (50%) 和重症新生儿发病率 (25%).
结论:
- 不孕症及其治疗与儿童患ASD风险略高有关.
- 产科和新生儿因素在这种关联中起着调解作用.
- 优化神经发育的策略在孩子出生的人与不孕不育应该考虑这些调解因素,即使在没有生育治疗的情况下.
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