Developmental Epidemiological Study of Children born through Reproductive Technology (DESCRT)

使用辅助生殖技术(ART)受孕的人数急剧增加。 在过去的30年里。此外，开发的体外受精(IVF)技术现在不需要 体外培养。这些广泛使用的非体外受精治疗(NIFT)增加了孩子的数量 有可能对健康造成不利影响。围产期并发症和分娩的短期风险增加 在艺术之后，缺陷是众所周知的。然而，这些不利后果的风险一直很难 特征是研究使用了不同的方法，检测的年龄不同，并且没有适当的 比较组。例如，当潜在的父母因素和不孕不育包括在分析中时 对于出生缺陷，这种联系实质上被削弱或完全消失。更重要的是，虽然 通过这些技术出生的儿童的长期健康是至关重要的公共卫生利益， 个人对家庭的兴趣，只有有限的数据存在。为了评估对长期健康的潜在风险， 通过ART和NIFT受孕的儿童，严格的流行病学方法，适当的特征 暴露、结果数据的标准化收集和适当的比较组是必需的。我们 建议建立生殖生育儿童发育流行病学研究 通过将加州大学旧金山分校治疗的患者的电子医疗记录(EMR)与出生联系起来的技术(DESCRT) 结果和健康数据。此外，作为纵向研究的一部分，13岁以下的儿童将被邀请 检查和探索性目标将调查风险增加的潜在机制。特别是， 我们计划：1)通过搜索EMR来建立流行病学队列和生物库，用于未来的研究 UCSF为2001-2015年间接受不孕症咨询的患者实现的所有妊娠。实验室 符合条件的妇女的治疗数据将与怀孕期间的数据联系起来。家庭将会是 跟踪并邀请儿童进行筛查。在接下来的4年内怀孕(2016- 2019年)将进行前瞻性招生；2)考察父母因素和不同生育方式的影响 通过分析特定生育力与儿童代谢风险的相关性制定儿童代谢风险的治疗策略 治疗和亲代因素，以及糖/胰岛素稳态和代谢组学参数 在一个探索性的目标中：检查早期子宫环境对子代的影响 通过评估胎盘功能的生物分析物和调查子宫血管来评估后代的代谢风险 在预期收集的妊娠期间，阻抗与胎盘的生长和功能。总体影响： 拟议研究的主要优点是人口众多，拥有完整和复杂的以下数据 暴露风险，形成有价值的生物库，以及具有先前研究的跨学科团队 建议关键的临床和翻译领域以研究为重点，改善患者信息并指导 对临床医生关于生育治疗安全性的建议。

The number of pregnancies conceived with assisted reproductive technology (ART) has dramatically increased over the last 30 years. Additionally, techniques developed for in vitro fertilization (IVF) are now utilized without in vitro culture. These widely-used non-IVF fertility treatments (NIFT) have increased the number of children potentially at risk for adverse health effects. Increased short-term risks for perinatal complications and birth defects, following ART, are well-known. However, the risk of these adverse outcomes has been difficult to characterize as studies used different methodologies, varied age of detection, and did not have appropriate comparison groups. For example, when underlying parental factors and infertility are included in the analyses of birth defects, the association is substantially weakened or disappears completely. More importantly, while the long-term health of children born through these technologies is of critical public health interest, and of personal interest to families, only limited data exist. In order to evaluate the potential risk for long-term health of children conceived through ART and NIFT, rigorous epidemiological methods, appropriate characterization of the exposure, standardized collection of outcome data, and appropriate comparison groups are required. We propose to establish a Developmental Epidemiological Study of Children born through Reproductive Technology (DESCRT) by linking the electronic medical records (EMR) of patients treated at UCSF with birth outcomes and health data. In addition, as part of the longitudinal study, children, up to age 13, will be invited for examination and exploratory aims will investigate underlying mechanisms for increased risk. In particular, we plan to: 1) Establish an epidemiological cohort and biobank for future studies by searching the EMR from UCSF for all pregnancies achieved in patients who underwent infertility consult during 2001–2015. Laboratory and treatment data for eligible women will be linked with the data on the course of pregnancy. Families will be traced and children invited for screening. Pregnancies achieved during the course of the next 4 years (2016- 2019) will be enrolled prospectively; 2) Examine the effects of parental factors and different reproductive treatment strategies on childhood metabolic risk by analyzing the correlation between specific fertility treatments and parental factors, and parameters of glucose/insulin homeostasis and metabolomics in the offspring; and in an Exploratory Aim: Examine the effects of early uterine environment on the precursors of metabolic risk in the offspring by evaluating bio-analytes of placental function and investigating uterine vascular impedance and placental growth and function during prospectively collected pregnancies. Overall impact: The major strengths of the proposed study are the large population with complete and complex data regarding exposure risk, the formation of a valuable biobank, and the interdisciplinary team with prior research suggesting key clinical and translational areas to focus the study improving information for patients and guiding recommendations for clinicians regarding safety of fertility treatment.