Assisted Reproductive Technology & Risk of Childhood Cancer

描述（由申请人提供）：在过去的二十年里，由于几个原因，包括高龄产妇生育和保险覆盖范围的增加，辅助生殖技术（ART）的使用在美国稳步上升。研究报告称，辅助妊娠与自然妊娠相比，围产期不良结局的风险显著更高，包括过度早产、低出生体重和出生缺陷。ART和/或不孕症可能会影响产前起源的其他疾病的发病率，如儿童癌症。此外，在ART受孕的儿童中，诸如Beckwith-Wiedemann和Angelman综合征等印记疾病的患病率升高;其中一些疾病反过来又大大增加了儿童早期发生的几种胚胎癌症的风险。辅助生殖和儿童癌症的几项队列、病例对照和病例系列研究报告了无效结果，尽管所有研究都受到样本量小的限制，无法区分特定的癌症类型。一项专门针对肝母细胞瘤的研究发现，使用不孕症治疗或辅助生殖与疾病风险增加9倍有关。利用辅助生殖技术协会（SART）的资源以及20个州和纽约市的出生和癌症登记处，我们建议进行迄今为止最大规模的ART和儿童癌症风险研究。根据1992年《联邦生育成功率和认证法案》[PL 102-493]的规定，SART维护着一个正在进行的在美国提供ART服务的项目的国家数据库。截至2006年，这是可获得数据的最近一年，其中包括关于483个诊所138 198个抗逆转录病毒疗法周期的综合数据（包括足以建立联系的标识符），一年中有41 343例怀孕和54 656例婴儿。我们建议将2004-2013年SART数据库的数据与20个州和纽约市的出生和癌症登记处的数据联系起来，包括ART出生人数最多的五个州（加州、纽约、伊利诺伊州、新泽西和马萨诸塞州），以创建一个约3000万儿童的队列，其中包括超过467名儿童，000人，用于评估辅助生殖与儿童癌症风险之间的关系。本研究的具体目的是比较辅助受孕儿童与普通人群儿童癌症的发病率。

DESCRIPTION (provided by applicant): Use of assisted reproductive technology (ART) has risen steadily in the United States during the past two decades due to several reasons, including childbearing at older maternal ages and increasing insurance coverage. Studies have reported significantly higher risks of adverse perinatal outcomes in assisted- versus spontaneous-conception pregnancies, including an excess of prematurity, low birthweight, and birth defects. ART and/or infertility may influence the incidence of other conditions with prenatal origins, such as childhood cancer. In addition, the prevalence of imprinting disorders such as Beckwith-Wiedemann and Angelman syndromes is elevated among children conceived by ART; some of these disorders, in turn, drastically raise the risk of several embryonal cancers that occur in early childhood. Several cohort, case-control, and case- series studies of assisted reproduction and childhood cancer have reported null results, although all were limited by small sample size and could not differentiate specific cancer types. One study that focused specifically on hepatoblastoma found that use of infertility treatment or assisted reproduction was associated with a nine-fold increased risk of disease. Using the resources of the Society for Assisted Reproductive Technology (SART) and the birth and cancer registries in 20 States and New York City, we propose to conduct the largest study to date of ART and childhood cancer risk. SART maintains an ongoing national database of programs that provide ART services in the United States as mandated by the federal Fertility Success Rate and Certification Act of 1992 [PL 102-493]. As of 2006, the latest year of data available, this included comprehensive data (including identifiers sufficient for linkage) on 138,198 ART cycles from 483 clinics resulting in 41,343 pregnancies and 54,656 infants for a single year. We propose to link the data from the SART database from 2004-2013 to the birth and cancer registries of 20 states and New York City, including the five states with the highest numbers of ART births (California, New York, Illinois, New Jersey, and Massachusetts), to create a cohort of approximately 30 million children, including over 467,000 conceived by ART to evaluate the association between assisted reproduction and the risk for childhood cancer. The specific aim of this study is to compare the incidence of childhood cancer in children with assisted conception to that in the general population.