Assisted Reproductive Technology and Risk of Childhood Cancers.
Assisted Reproductive Technology and Risk of Childhood Cancers.
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DOI：
10.1001/jamanetworkopen.2022.30157
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发表时间：
2022-08-01
影响因子：
13.8
通讯作者：
Chien, Li-Yin
中科院分区：
文献类型：
--
作者：
Weng, Shiue-Shan;Huang, Yen-Tsung;Huang, Yi-Ting;Li, Yi-Ping;Chien, Li-Yin
通过辅助生殖技术（ART）怀孕的儿童患儿童癌症的风险更高吗？在这项全国性的基于人群的队列研究中，在台湾的2308016个父母-孩子三联体，通过ART怀孕的孩子在统计学上显着增加儿童癌症的风险比自然怀孕的孩子和那些出生的父母诊断为不孕症谁没有使用ART。这种关联是不介导早产和低出生体重。研究结果表明，ART概念与儿童癌症风险增加有关，并且风险增加不能归因于早产或低出生体重。这项队列研究探讨了台湾通过辅助生殖技术怀孕的儿童患儿童癌症的风险。通过使用辅助生殖技术出生的儿童人数一直在增加。这些儿童可能有更高的表观遗传改变和不良围产期结果的风险，这可能与儿童癌症有关。确定不同受孕方式与儿童期癌症之间的关联，以及早产和低出生体重的潜在中介作用。这项全国性的、基于人群的队列研究纳入了2004年1月1日至2017年12月31日期间台湾2308016名合格亲子三合会的登记数据。共有1880名儿童被确定患有儿童癌症。分析了2020年9月1日至2022年6月30日期间的数据。受孕方式，定义为（1）自然受孕，（2）生育力低下和非ART（即不孕症诊断但无ART辅助受孕），或（3）ART（即不孕症诊断和ART辅助受孕）。根据国际儿童癌症分类，第三版诊断儿童癌症。父亲和母亲的平均（SD）年龄分别为33.28（5.07）和30.83（4.56）岁。在2 308 016名儿童中，52.06%为男孩，8.16%为早产，7.38%为低出生体重。在1490万人-年的随访期间（中位数，6年[IQR，3-10年]），与自然受孕（风险比，1.58; 95%CI，1.17-2.12）和非ART受孕的生育力低下（风险比，1.42; 95%CI，1.04-1.95）相比，ART受孕与任何类型的儿童癌症风险增加相关。接受辅助生殖技术的儿童患癌风险增加主要是由于白血病和肝癌。与ART受孕相关的癌症风险增加并非由早产或低出生体重介导。在这项队列研究中，通过ART受孕的儿童患儿童癌症的风险高于自然受孕的儿童，而那些患有不孕症的父母未使用ART的儿童。
Are children conceived via assisted reproductive technology (ART) at a higher risk of childhood cancers? In this nationwide population-based cohort study of 2 308 016 parents-child triads in Taiwan, children conceived via ART were at a statistically significant increased risk for childhood cancers compared with children conceived naturally and those born to parents with an infertility diagnosis who did not use ART. This association was not mediated by preterm birth and low birth weight. The findings suggest that ART conception is associated with an increased risk for childhood cancers, and the increased risk cannot be attributed to preterm birth or low birth weight. This cohort study examines the risk of childhood cancers among children conceived by assisted reproductive technology in Taiwan. The number of children born through the use of assisted reproductive technology (ART) has been increasing. These children may have higher risks for epigenetic alteration and adverse perinatal outcomes, which may be associated with childhood cancers. To determine the associations between different modes of conception and childhood cancers and potential mediation by preterm birth and low birth weight. This nationwide, population-based cohort study included registry data from 2 308 016 eligible parents-child triads in Taiwan from January 1, 2004, to December 31, 2017. A total of 1880 children with incident childhood cancer were identified. Data were analyzed between September 1, 2020, and June 30, 2022. Mode of conception, defined as (1) natural conception, (2) subfertility and non-ART (ie, infertility diagnosis but no ART-facilitated conception), or (3) ART (ie, infertility diagnosis and ART-facilitated conception). Diagnosis of childhood cancer according to the International Classification of Childhood Cancers, Third Edition. The mean (SD) paternal and maternal ages were 33.28 (5.07) and 30.83 (4.56) years, respectively. Of the 2 308 016 children, 52.06% were boys, 8.16% were born preterm, and 7.38% had low birth weight. During 14.9 million person-years of follow-up (median, 6 years [IQR, 3-10 years]), ART conception was associated with an increased risk of any type of childhood cancers compared with natural conception (hazard ratio, 1.58; 95% CI, 1.17-2.12) and subfertility with non-ART conception (hazard ratio, 1.42; 95% CI, 1.04-1.95). The increased cancer risk of children conceived with ART was mainly owing to leukemia and hepatic tumor. The increased cancer risk associated with ART conception was not mediated by preterm birth or low birth weight. In this cohort study, children conceived via ART had a higher risk of childhood cancers than those conceived naturally and those born to parents with an infertility diagnosis did not use ART. The increased risk could not be explained by preterm birth or low birth weight.
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