目的:接受ART的儿童患青春期障碍的风险增加吗?
结论:接受ART的男孩和女孩患青春期障碍的风险都较高;青春期早在女孩中更常见,青春期晚在男孩中。
背景:据报道,与未接受ART的儿童相比,接受ART的儿童在生长和代谢方面存在一些生理差异。对ART受孕儿童的青春期发育和疾病的了解有限。
方法:进行了一项基于注册的队列研究,包括1985年至2015年的数据。北欧辅助生殖技术和安全委员会(CoNARTaS)研究人群包括所有活产和死产儿童,以及他们的母亲,在丹麦的研究期间在医学出生登记簿中注册,瑞典,芬兰和挪威。
方法:共有122,321个由ART构思的单身人士和6,576,410个非ART单身人士出生在丹麦(1994-2014年),芬兰(1990-2014),挪威(2002-2015)和瑞典(1985-2015)被包括在内。青春期障碍使用国际疾病和相关健康问题分类(ICD)-9/ICD-10代码定义,并分为以下组:青春期晚期(6268/E30.0),青春期早期(2591和2958/E30.1和E30.8)和未指明的疾病(芬兰的V212和V579/E30.9和Z00.3以及Z51.80)。Cox回归的结果根据产妇年龄进行了调整,奇偶校验,吸烟,妊娠期糖尿病,慢性高血压,怀孕和国家期间的高血压疾病,进一步对于胎龄,出生体重,胎龄小或胎龄大。
结果:有37869名诊断与青春期障碍有关的儿童,其中603人出生在ART之后。接受ART治疗的儿童在早期(校正风险比(aHR)1.45,95%CI:1.29-1.64)和晚期青春期(aHR1.47,95%CI:1.21-1.77)的风险较高。女孩的诊断与青春期早期有关(aHR1.46,95%CI:1.29-1.66),男孩的诊断与青春期晚期有关(aHR1.55,95%CI:1.24-1.95)。
结论:在医疗保健登记册中使用已报告的带有ICD代码的青春期疾病可能会有所不同,这可能会影响寄存器中发现的案件数量。登记数据可能会低估ART和非ART受孕的儿童,特别是在非ART儿童中,他们可能不像ART构思的孩子那样被仔细跟踪。调整不孕症的原因和持续时间,母亲自己的青春期特征和BMI,以及儿童的BMI,是不可能的,因为没有数据或数据丢失的早期。也不可能将ART与非ART兄弟姐妹进行比较,或者由于少数不一致的兄弟姐妹对和大部分关于不育症原因的数据缺失,无法通过不育症的原因研究青春期障碍。
结论:这个大,基于登记的研究表明,接受ART治疗的儿童患青春期障碍的风险更高.然而,不孕和青春期发病的机制是复杂的,ART是一个快速发展的领域,具有各种治疗选择。研究ART受孕后代的青春期障碍是一个持续的挑战。
背景:这项工作得到了北欧试验联盟的支持:一个由北欧部长理事会和NordForsk(71450)共同资助的试点项目,挪威中部地区卫生当局(46045000),北欧妇产科联合会(NF13041,NF15058,NF16026和NF17043),Interreg厄勒海峡-卡特加特-斯卡格拉克欧洲区域发展基金(ReproUnion项目),挪威卓越中心研究理事会资助计划(262700),根据瑞典政府和县议会之间的协议,ALF协议(ALFGBG-70940)和通量联盟“通量原因中的家族形成”,后果和可能的未来,由战略研究委员会资助,芬兰学院(人口学345130)。资助者在研究设计中没有作用,数据收集和分析,决定出版或准备手稿。作者没有利益冲突要披露。
背景:不适用。
OBJECTIVE: Do ART-conceived children have an increased risk for puberty disorders?
CONCLUSIONS: Both ART-conceived boys and girls had a higher risk of puberty disorders; early puberty was more common among girls and late puberty among boys.
BACKGROUND: Some physiological differences in growth and metabolism have been reported for ART-conceived children compared to non-ART-conceived children. Knowledge on pubertal development and disorders in ART-conceived children is limited.
METHODS: A register-based cohort study was carried out including data from 1985 to 2015. The Committee of Nordic Assisted Reproductive Technology and Safety (CoNARTaS) study population consists of all live and stillborn children, as well as their mothers, registered in the Medical Birth Registers during the study period in Denmark, Sweden, Finland and Norway.
METHODS: A total of 122 321 ART-conceived singletons and 6 576 410 non-ART singletons born in Denmark (1994-2014), Finland (1990-2014), Norway (2002-2015) and Sweden (1985-2015) were included. Puberty disorders were defined using International Classification of Diseases and Related Health Problems (ICD)-9/ICD-10 codes and classified in the following groups: late puberty (6268/E30.0), early puberty (2591 and 2958/E30.1 and E30.8) and unspecified disorders (V212 and V579/E30.9 and Z00.3 as well as Z51.80 for Finland). The results in Cox regression were adjusted for maternal age, parity, smoking, gestational diabetes, chronic hypertension, hypertensive disorders during pregnancy and country, and further for either gestational age, birthweight, small for gestational age or large for gestational age.
RESULTS: There were 37 869 children with diagnoses related to puberty disorders, and 603 of them were born after ART. ART-conceived children had higher risks for early (adjusted hazard ratio (aHR) 1.45, 95% CI: 1.29-1.64) and late puberty (aHR 1.47, 95% CI: 1.21-1.77). Girls had more diagnoses related to early puberty (aHR 1.46, 95% CI: 1.29-1.66) and boys with late puberty (aHR 1.55, 95% CI: 1.24-1.95).
CONCLUSIONS: Using reported puberty disorders with ICD codes in health care registers might vary, which may affect the numbers of cases found in the registers. Register data may give an underestimation both among ART and non-ART-conceived children, especially among non-ART children, who may not be as carefully followed as ART-conceived children. Adjustment for causes and duration of infertility, mothers\' own puberty characteristics and BMI, as well as children\'s BMI, was not possible because data were not available or data were missing for the early years. It was also not possible to compare ART to non-ART siblings or to study the pubertal disorders by cause of subfertility owing to a small number of discordant sibling pairs and a large proportion of missing data on cause of subfertility.
CONCLUSIONS: This large, register-based study suggests that ART-conceived children have a higher risk for puberty disorders. However, the mechanisms of infertility and pubertal onset are complex, and ART is a rapidly advancing field with various treatment options. Studying the pubertal disorders of ART-conceived offspring is a continuing challenge.
BACKGROUND: This work was supported by the Nordic Trial Alliance: a pilot project jointly funded by the Nordic Council of Ministers and NordForsk (71450), the Central Norway Regional Health Authorities (46045000), the Nordic Federation of Obstetrics and Gynaecology (NF13041, NF15058, NF16026 and NF17043), the Interreg Öresund-Kattegat-Skagerrak European Regional Development Fund (ReproUnion project), the Research Council of Norway\'s Centre of Excellence funding scheme (262700), the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (ALFGBG-70940) and FLUX Consortium \'Family Formation in Flux-Causes, Consequences and Possible Futures\', funded by the Strategic Research Council, Academy of Finland (DEMOGRAPHY 345130). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The authors have no conflicts of interest to disclose.
BACKGROUND: N/A.