Fertility treatments and pediatric neoplasms of the offspring: results of a population-based cohort with a median follow-up of 10 years
Fertility treatments and pediatric neoplasms of the offspring: results of a population-based cohort with a median follow-up of 10 years
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DOI：
10.1016/j.ajog.2017.01.015
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发表时间：
2017-03-01
影响因子：
9.8
通讯作者：
Sheiner, Eyal
中科院分区：
文献类型：
--
作者：
Wainstock, Tamar;Walfisch, Asnat;Sheiner, Eyal
目的：研究质疑生育治疗后受孕的后代的长期健康影响。（体外受精、促排卵或自然妊娠）和肿瘤风险（良性和恶性肿瘤）的后代;我们观察了后代长达18年。研究设计：进行了一项基于人群的队列分析，根据受孕方式比较了儿童（18岁以下）的肿瘤风险。肿瘤诊断基于该地区同一个三级中心的医院记录。研究纳入了1991-2013年期间出生并存活出院的所有单胎婴儿。从分析中排除了先天性畸形的后代。构建Kaplan-Meier生存曲线以比较累积肿瘤发生率;多变量生存分析用于控制混杂因素，包括胎龄、妊娠并发症和母体因素。1721例（0.7%）在促排卵治疗后受孕，237，863例（98.3%）是自然受孕。在随访期间（中位数，10.55年），1498肿瘤（0.6%）被诊断。与自然受孕的儿童相比，体外受精（1.5/1000人年）或促排卵治疗（1.0/1000人年）后受孕的儿童的肿瘤发病率密度更高（0.59/1000人年; Kaplan-Meier对数秩，P
OBJECTIVE: Studies have questioned the long-term health effects of offspring conceived after fertility treatments.METHODS: We aimed to evaluate whether an association exists between mode of conception (in vitro fertilization, ovulation induction, or spontaneous pregnancy) and neoplasm risk (both benign and malignant tumors) among the offspring; we observed the offspring for up to 18 years.STUDY DESIGN: A population-based cohort analysis was performed that compared the risk for neoplasms among children (up to the age of 18 years) based on mode of conception. Neoplasm diagnoses were based on hospital records of the same single tertiary center in the region. All singletons born during from 1991-2013 and discharged alive were included in the study. Offspring with congenital malformations were excluded from the analysis. Kaplan-Meier survival curves were constructed to compare cumulative neoplasms incidence; multivariable survival analyses were used to control for confounders that included gestational age, pregnancy complications, and maternal factors.RESULTS: During the study period, 242,187 newborn infants met the inclusion criteria: 2603 (1.1%) were conceived after in vitro fertilization; 1721 (0.7%) were conceived after ovulation induction treatments, and 237,863 (98.3%) were conceived spontaneously. During the follow-up period (median, 10.55 years), 1498 neoplasms (0.6%) were diagnosed. Incidence density rate for neoplasms was higher among children conceived either after in vitro fertilization (1.5/1000 person years) or ovulation induction treatments (1.0/1000 person years), as compared with naturally conceived children (0.59/1000 person years; Kaplan-Meier log rank, P