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Multiplicity and early gestational age contribute to an increased risk of cerebral palsy from assisted conception:a population-based cohort study
Journal article   Open access   Peer reviewed

Multiplicity and early gestational age contribute to an increased risk of cerebral palsy from assisted conception:a population-based cohort study

Dorte Hvidtjørn, Jakob Grove, Diana Schendel, Laura Schieve, Claus Sværke, Bo Jacobsson, Peter Vilhelm Uldall, Erik Ernst, Poul Thorsen and Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi
Human reproduction (Oxford), v 25(8), pp 2115-23
01 Aug 2010
DOI: https://doi.org/10.1093/humrep/deq070
PMID: 20554642
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1093/humrep/deq070View
Published, Version of Record (VoR) Open

Abstract

Adolescent Adult Cerebral Palsy Child Cohort Studies Denmark Female Fertilization in Vitro Follow Gestational Age Humans Infant Multiple Birth Offspring Newborn Premature Prevalence Risk Assessment Risk Factors Up Studies
BACKGROUND:This paper assesses the risk of cerebral palsy (CP) in children born after assisted conception compared with children born after natural conception (NC).METHODS:This population based follow-up study included all 588,967 children born in Denmark from 1995 to 2003. Assisted conception was defined as IVF, with or without ICSI, and ovulation induction (OI), with or without subsequent insemination.RESULTS:There were 33 139 (5.6%) children born in Denmark from 1995 to 2003 as a result of assisted conception and through to June 2009, 1146 (0.19%) children received a CP diagnosis. Children born after assisted conception had an increased risk of a CP diagnosis, crude hazard rate ratio (HRR) 1.90 (95% CI: 1.57-2.31) compared with NC children. Divided into IVF and OI children compared with NC children, the risk was HRR 2.34 (95% CI: 1.81-3.01) and HRR 1.55 (95% CI: 1.17-2.06), respectively. When we included the intermediate factors multiplicity and gestational age in multivariate models, the risk of CP in assisted conception disappeared. In general, children with CP born after assisted conception had similar CP subtypes and co-morbidities as children with CP born after NC.CONCLUSION:The risk of CP is increased after both IVF and OI. The increased risk of CP in children born after assisted conception, and in particular IVF, is strongly associated with the high proportion of multiplicity and preterm delivery in these pregnancies. A more widespread use of single embryo transfer warrants consideration to enhance the long-term health of children born after IVF. BACKGROUND: This paper assesses the risk of cerebral palsy (CP) in children born after assisted conception compared with children born after natural conception (NC).METHODS: This population based follow-up study included all 588,967 children born in Denmark from 1995 to 2003. Assisted conception was defined as IVF, with or without ICSI, and ovulation induction (OI), with or without subsequent insemination.RESULTS: There were 33 139 (5.6%) children born in Denmark from 1995 to 2003 as a result of assisted conception and through to June 2009, 1146 (0.19%) children received a CP diagnosis. Children born after assisted conception had an increased risk of a CP diagnosis, crude hazard rate ratio (HRR) 1.90 (95% CI: 1.57-2.31) compared with NC children. Divided into IVF and OI children compared with NC children, the risk was HRR 2.34 (95% CI: 1.81-3.01) and HRR 1.55 (95% CI: 1.17-2.06), respectively. When we included the intermediate factors multiplicity and gestational age in multivariate models, the risk of CP in assisted conception disappeared. In general, children with CP born after assisted conception had similar CP subtypes and co-morbidities as children with CP born after NC.CONCLUSION: The risk of CP is increased after both IVF and OI. The increased risk of CP in children born after assisted conception, and in particular IVF, is strongly associated with the high proportion of multiplicity and preterm delivery in these pregnancies. A more widespread use of single embryo transfer warrants consideration to enhance the long-term health of children born after IVF.

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This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being
#5 Gender Equality

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Obstetrics & Gynecology
Reproductive Biology
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