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

通过辅助生殖技术（ART）怀孕的人数急剧增加 在过去的30年里。此外，现在使用为体外受精（IVF）开发的技术， 离体培养这些广泛使用的非试管婴儿生育治疗（NIFT）增加了孩子的数量 可能对健康造成不良影响。围产期并发症和分娩的短期风险增加 ART之后的缺陷是众所周知的。然而，这些不良后果的风险一直难以控制。 描述为研究使用不同的方法，不同的检测年龄，并且没有适当的 对照组。例如，当分析中包括潜在的父母因素和不孕症时， 在出生缺陷中，这种关联大大减弱或完全消失。更重要的是， 通过这些技术出生的儿童的长期健康具有关键的公共卫生利益， 家庭的个人利益，只有有限的数据。为了评估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， 需要暴露、标准化的结果数据收集和适当的比较组。我们 建议对通过生殖途径出生的儿童进行发育流行病学研究， 通过将在UCSF接受治疗的患者的电子病历（EMR）与出生联系起来， 结果和健康数据。此外，作为纵向研究的一部分，将邀请13岁以下的儿童 为了检查和探索的目的，将调查增加风险的潜在机制。特别是， 我们计划：1）通过检索EMR，建立流行病学队列和生物库，为未来的研究奠定基础。 UCSF用于2001-2015年期间接受不孕症咨询的患者的所有妊娠。实验室 符合条件的妇女的治疗数据将与怀孕过程的数据联系起来。家庭将 跟踪并邀请儿童进行筛查。未来4年（2016年至2018年）的怀孕率 2019）将前瞻性入组; 2）检查父母因素和不同生殖因素的影响 通过分析特定生育率与儿童代谢危险的相关性， 治疗和父母因素，以及葡萄糖/胰岛素稳态和代谢组学参数， 后代;并在一个探索性的目的：检查早期子宫环境对前体的影响， 通过评估胎盘功能的生物分析物和研究子宫血管， 阻抗和胎盘生长和功能。总体影响： 拟议研究的主要优势是人口众多，数据完整而复杂， 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 建议重点临床和翻译领域，以关注研究，改善患者信息， 关于生育治疗安全性的临床医生建议。

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.