MRC Transition Support Award: Long-term health outcomes for women & their children after assisted reproductive technologies: a data linkage study

MRC 转型支持奖：女性的长期健康成果

• 批准号: MR/W029286/1
• 负责人: Claire Carson
• 金额: $ 9.47万
• 依托单位: University of Oxford
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2022
• 资助国家: 英国
• 起止时间: 2022 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FW029286%2F1
• 关键词: MRC; Transition; Support; Award; Long

Infertility affects 1 in 7 couples, and the number of babies using Assisted Reproductive Technologies (ART) such as IVF is increasing. Since 1991 over 390,000 children have been born in the UK as a result of ART, which now accounts for about 2% of births each year. Most IVF births result in healthy children, but there is good evidence that IVF pregnancies are at higher risk of poor perinatal outcomes (prematurity, low birth weight, a higher incidence of caesarean section), congenital malformations and some rare epigenetic syndromes. Cognitive, developmental and behavioural problems have also been identified, though the evidence is limited and findings are less convincing - in part, because studies in this area are difficult to conduct and sometimes flawed. Higher rates of other adverse outcomes, such as asthma and autism, have also been reported but, again, the evidence is sparse. Studies of health and developmental outcomes of children born after ART tend to focus only on early childhood, so that the long term health and development of ART children is still relatively under-researched. There are also well-recognised risks to the woman at the time of ART treatment, and the negative impact of unsuccessful treatment on women and their partners has been documented. However, when treatment is successful the longer-term implications for the mother are often overlooked. The difficulty of becoming pregnant, perceived high-risk pregnancies and anxiety about birth can all have a lasting impact. The incidence of postnatal depression is higher after ART, and sufferers appear to be more vulnerable to later depressive episodes. Fears about increased cancer risks in women who have undergone treatment appear unfounded, but there remain unanswered questions regarding long-term impacts of ART on maternal physical and mental health, and use of health services. This Transition Support Award seeks to consolidate the research outlined in an existing Career Development Award held by Dr Claire Carson, an epidemiologist at the National Perinatal Epidemiology Unit, University of Oxford. The research seeks to address the issues outlined above, and provide evidence for the health and wellbeing of ART mothers and their children in the longer term. The project uses data that is collected by infertility clinics (on behalf of the Human Fertilisation and Embryology Authority) on all ART treatments in the UK since 1991, and links it to GP medical records for the women and their children held in the Clinical Practice Research Datalink mother-baby dataset. It is anticipated that over 400,000 mother-baby pairs will be included, of whom about 8,000 will have been born after ART. The oldest children will have been followed up for over 20 years. We will be exploring the health of children and their mothers using information that is recorded by the doctor or nurse practitioner when they visit their doctor's surgery, such as diagnoses of medical conditions, prescriptions for medication and referrals for specialist treatment. The increased use of health services, if any, among ART mother-baby pairs will also be assessed.

每7对夫妇中就有1对不孕不育，使用体外受精等辅助生殖技术(ART)的婴儿数量正在增加。自1991年以来，英国有超过39万名儿童因抗逆转录病毒治疗而出生，现在每年约占出生人数的2%。大多数试管婴儿的出生都是健康的，但有很好的证据表明，试管婴儿的围产期结局不良(早产、低出生体重、剖腹产发生率较高)、先天性畸形和一些罕见的表观遗传综合征的风险更高。认知、发展和行为问题也已被发现，尽管证据有限，研究结果不那么令人信服--部分原因是这一领域的研究很难进行，有时还存在缺陷。其他不良后果的发生率也较高，如哮喘和自闭症，但同样，证据很少。对抗逆转录病毒治疗后出生的儿童的健康和发展结果的研究往往只关注儿童早期，因此对抗逆转录病毒治疗儿童的长期健康和发展研究仍然相对不足。在接受抗逆转录病毒治疗时，妇女也有公认的风险，治疗失败对妇女及其伴侣的负面影响已有记录。然而，当治疗成功时，对母亲的长期影响往往被忽视。怀孕的困难、被认为是高危怀孕以及对分娩的焦虑都可能产生持久的影响。接受抗逆转录病毒治疗后，产后抑郁症的发生率更高，患者似乎更容易受到后来的抑郁发作的影响。对接受治疗的女性癌症风险增加的担忧似乎是没有根据的，但关于抗逆转录病毒治疗对产妇身心健康和卫生服务使用的长期影响的问题仍然没有得到回答。这一过渡支持奖旨在巩固牛津大学国家围产期流行病学部流行病学家克莱尔·卡森博士在现有职业发展奖中概述的研究。这项研究旨在解决上述问题，并为抗逆转录病毒治疗母亲及其子女的健康和福祉提供长期证据。该项目使用了不孕不育诊所(代表人类受精和胚胎学管理局)收集的1991年以来英国所有抗逆转录病毒治疗的数据，并将其与临床实践研究数据链接母婴数据集中持有的妇女及其孩子的全科医生医疗记录联系起来。预计将包括40多万对母婴，其中约8,000对将在ART后出生。年龄最大的孩子将接受20多年的跟踪调查。我们将使用医生或护士在他们看医生的手术时记录的信息来探索儿童及其母亲的健康状况，例如医疗状况的诊断、药物处方和专科治疗的转介。还将评估抗逆转录病毒母婴配对中增加使用卫生服务的情况。

项目成果

Long-term healthcare utilization and costs of babies born after assisted reproductive technologies (ART): a record linkage study with 10-years' follow-up in England.

辅助生殖技术（ART）出生的长期医疗保健利用和成本：一项创纪录的联系研究，并在英格兰进行了10年的随访。

• DOI: 10.1093/humrep/dead198
• 发表时间: 2023-12-04
• 期刊: Human reproduction (Oxford, England)