Assisted Reproductive Technologies and Risk of Autism and Other Developmental Disabilities

项目摘要 该项目旨在扩大以前授予的探索性R21赠款的成功， 将来自三个不同来源的复杂行政数据集联系起来的能力， 从辅助生殖技术（ART），和自闭症诊断在加州。本研究的目的是 建立和分析现有的关于ART和发育障碍的最大和最详细的数据集 包括自闭症，智力残疾和脑瘫，在一个大的和多样化的状态，最终目标是 了解ART与这些疾病风险之间的关系。我们成功地将 加州出生主文件到疾病预防控制中心的国家辅助生殖技术监测系统 加州生育诊所的登记处，以及自闭症和接受发育服务的结果数据， 1996年至2007年的出生队列，并公布了这一数据集的初步调查结果。我们寻求下一步扩大 为了更详细地评估ART与自闭症之间的关系以及 其他发展障碍。首先，我们建议将加州出生的额外队列纳入其中， 至少到2016年的概念，至少到2020年的成果。这将使数据集扩展到更多 超过1100万新生儿，约123，000 ART新生儿，约65，000自闭症病例。这也将扩大我们的 这是一个前所未有的特征，在基于人口的数据集中， 允许我们检查ART的长期发展后果。此外，我们将包括以下数据： 脑瘫和智力残疾的诊断。接下来，我们将从几个方面扩展我们的分析：1） 通过分析以下因素之间的关联变化，加强我们在这个更大数据集中的初步发现： 不孕症和ART程序的亚组以及潜在的中介变量，如产科并发症 和效果调节剂，如母亲肥胖; 2）通过以下方式模拟自闭症的长期症状表达： 青春期，并测试这些模式是否不同的概念组; 3）使用兄弟姐妹对不和谐的 ART概念，以评估家庭特征混淆的作用; 4）检查 ART与智力残疾和脑瘫; 5）评估邻里特征所起的作用 ART和发育障碍之间的联系。在自闭症迅速增加的背景下， 流行率和ART在生殖决策中日益重要的作用，这项研究 显著的科学和公共卫生影响。通过阐明与之相关的长期发育风险， 通过对ART患者的特定治疗/亚组，该项目有可能做出重大贡献 我们对自闭症和其他发育障碍的病因学的理解， 建议和使用具体程序的考虑因素。

Project Summary This project seeks to expand on the success of an exploratory R21 grant previously awarded to establish capacity to link complex administrative data sets from three separate sources reporting births, conceptions from assisted reproductive technology (ART), and autism diagnoses in California. The goal of this research is to build and analyze the largest and most detailed dataset in existence on ART and developmental disabilities including autism, intellectual disability, and cerebral palsy, in a large and diverse state, with the ultimate aim of understanding the relationship between ART and risk of these disorders. We have successfully linked the California Birth Master Files to the CDC's National Assisted Reproductive Technology Surveillance System registry for California fertility clinics and to outcome data on autism and receipt of developmental services for the 1996 to 2007 birth cohorts, and published initial findings from this dataset. We seek next to expand the project significantly in order to assess in greater detail the relationship between ART and autism as well as other developmental disabilities. First, we propose to incorporate additional cohorts of California births and conceptions through at least 2016, and outcomes through at least 2020. This will expand the data set to more than eleven million births, about 123,000 ART births, and about 65,000 autism cases. This will also expand our follow-up period into early adulthood, an unprecedented feature in a population-based dataset this large that allows us to examine long-term developmental consequences of ART. In addition, we will include data on diagnoses of cerebral palsy and intellectual disability. Next, we will expand our analyses in several ways: 1) strengthen our preliminary findings in this much larger dataset by analyzing variation in the association among subgroups of infertility and ART procedure as well as potential mediating variables like obstetric complications and effect modifiers like maternal obesity; 2) model the long-term symptom expression of autism through adolescence, and test whether these patterns differ by conception group; 3) use sibling pairs discordant for ART conception to assess the role of confounding by family characteristics; 4) examine the association between ART and intellectual disability and cerebral palsy; and 5) assess the role that neighborhood characteristics play in the association between ART and developmental disabilities. Against the background of rapidly rising autism prevalence and the increasingly important role of ART in reproductive decision-making, this research has notable scientific and public health implications. By elucidating the long term developmental risks associated with specific treatments/subsets of ART patients, this project has the potential to make significant contributions to our understanding of the etiology of autism and other developmental disabilities, and to risk-benefit considerations for the recommendation and usage of specific procedures.