Assisted Reproductive Technologies and Increased Autism Risk

描述（由申请人提供）：该项目将连接现有的人口水平数据集，该数据集包括1996年至2006年期间所有加州出生的婴儿（超过500万儿童，超过100万人）。 60，000对双胞胎和超过100万个完全和半兄弟姐妹组）和自闭症的结果数据以及同期加州不孕症诊所向CDC国家辅助生殖技术监测系统登记处提供的发育服务。我们将使用来自一个大的种族和地理上多样化的州的详细数据集来评估辅助生殖技术（ART）（包括体外受精和相关程序）与自闭症之间的关系（如果有的话），并确定这种关联运作的途径。近几十年来，ART和自闭症都迅速增加，尽管人们普遍怀疑两者之间存在关系，但现有的研究报告了混合和不确定的结果，主要是由于样本不足。我们的设计，使我们能够确定约50，000 ART出生和约24，000例自闭症障碍超过连续十年，克服了以前的局限性，并承诺能够准确估计与ART相关的自闭症风险。此外，我们将有关于儿童，父母和家庭特征，出生时居住，ART方法和程序的详细信息，自闭症的结果将使我们更好地理解其中的机制。有了这些信息，我们可以1）确定这种关联是否受到自闭症和ART选择性个体特征的混淆，例如父母年龄，SES和不孕因素; 2）确定ART和自闭症之间观察到的关联是否在ART协议中是统一的，或者特定于某些方法; 3）探索临床水平因素的作用;以及 4)确定ART和自闭症之间的时间和空间关联。在自闭症患病率迅速上升和ART在生殖决策中的作用日益重要的背景下，这项研究具有重要的科学和公共卫生意义。这个项目有可能对我们的理解做出重大贡献 自闭症的病因学以及ART分娩的长期结果，两者都没有得到很好的理解。

DESCRIPTION (provided by applicant): This project will link an existing population level dataset consisting of all California births between 1996 and 2006 (over five million children, over 60,000 twin pairs, and over 1 million full and half sibling groups) and outcome data on autism and receipt of developmental services to the CDC's National Assisted Reproductive Technology Surveillance System registry for California infertility clinics for the same period. We will use ths detailed dataset from a large ethnically and geographically diverse state to assess the relationship, if any, between Assisted Reproductive Technology (ART), including in vitro fertilization and related procedures, and autism and to identify the pathways through which this association operates. ART and autism have both increased rapidly in recent decades, and although a relationship is widely suspected, existing research has reported mixed and inconclusive findings, largely a result of insufficient samples. Our design, which enables us to identify about 50,000 ART births and about 24,000 cases of autistic disorder over ten consecutive years, overcomes previous limitations and promises to enable an accurate estimation of autism risk associated with ART. Further, the detailed information we will have on child, parent and family characteristics, residence at birth, ART methods and procedures, and autism outcomes will allow us to better understand the mechanisms at play. With this information, we can 1) identify whether such an association is confounded by individual characteristics selective for both autism and ART, such as parental age, SES, and infertility factors; 2) identify whether an observed association between ART and autism is uniform across ART protocols or is specific to certain method(s); 3) explore the role of clinic-level factors; and 4) ascertain the temporal and spatial correlates of the association of ART and autism. Against the background of rapidly rising autism prevalence and the increasingly important role of ART in reproductive decision-making, this research has important scientific and public health implications. This project has the potential to make significant contributions to our understanding of the etiology of autism as well as the long-term outcomes of ART births, neither of which are well understood.