Infertility and Risk of Autism Spectrum Disorder in Children.
JAMA Netw Open
; 6(11): e2343954, 2023 Nov 01.
Article
in En
| MEDLINE
| ID: mdl-37983032
ABSTRACT
Importance Previous studies on the risk of childhood autism spectrum disorder (ASD) following fertility treatment did not account for the infertility itself or the mediating effect of obstetrical and neonatal factors. Objective:
To assess the association between infertility and its treatments on the risk of ASD and the mediating effect of selected adverse pregnancy outcomes on that association. Design, Setting, andParticipants:
This was a population-based cohort study in Ontario, Canada. Participants were all singleton and multifetal live births at 24 or more weeks' gestation from 2006 to 2018. Data were analyzed from October 2022 to October 2023. Exposures The exposure was mode of conception, namely, (1) unassisted conception, (2) infertility without fertility treatment (ie, subfertility), (3) ovulation induction (OI) or intrauterine insemination (IUI), or (4) in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Main Outcome andMeasures:
The study outcome was a diagnosis of ASD at age 18 months or older. Cox regression models generated hazard ratios (HR) adjusted for maternal and infant characteristics. Mediation analysis further accounted for the separate effect of (1) preeclampsia, (2) cesarean birth, (3) multifetal pregnancy, (4) preterm birth at less than 37 weeks, and (5) severe neonatal morbidity.Results:
A total of 1â¯370â¯152 children (703â¯407 male [51.3%]) were included 1â¯185â¯024 (86.5%) with unassisted conception, 141â¯180 (10.3%) with parental subfertility, 20â¯429 (1.5%) following OI or IUI, and 23â¯519 (1.7%) following IVF or ICSI. Individuals with subfertility or fertility treatment were older and resided in higher-income areas; the mean (SD) age of each group was as follows 30.1 (5.2) years in the unassisted conception group, 33.3 (4.7) years in the subfertility group, 33.1 (4.4) years in the OI or IUI group, and 35.8 (4.9) years in the IVF or ICSI group. The incidence rate of ASD was 1.93 per 1000 person-years among children in the unassisted conception group. Relative to the latter, the adjusted HR for ASD was 1.20 (95% CI, 1.15-1.25) in the subfertility group, 1.21 (95% CI, 1.09-1.34) following OI or IUI, and 1.16 (95% CI, 1.04-1.28) after IVF or ICSI. Obstetrical and neonatal factors appeared to mediate a sizeable proportion of the aforementioned association between mode of conception and ASD risk. For example, following IVF or ICSI, the proportion mediated by cesarean birth was 29%, multifetal pregnancy was 78%, preterm birth was 50%, and severe neonatal morbidity was 25%. Conclusions and Relevance In this cohort study, a slightly higher risk of ASD was observed in children born to individuals with infertility, which appears partly mediated by certain obstetrical and neonatal factors. To optimize child neurodevelopment, strategies should further explore these other factors in individuals with infertility, even among those not receiving fertility treatment.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Premature Birth
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Autism Spectrum Disorder
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Infertility
Limits:
Adult
/
Child
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Female
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Humans
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Infant
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Male
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Newborn
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Pregnancy
Country/Region as subject:
America do norte
Language:
En
Journal:
JAMA Netw Open
Year:
2023
Document type:
Article
Affiliation country:
Canada