TY - JOUR
T1 - Fertility treatments and pediatric neoplasms of the offspring
T2 - results of a population-based cohort with a median follow-up of 10 years
AU - Wainstock, Tamar
AU - Walfisch, Asnat
AU - Shoham-Vardi, Ilana
AU - Segal, Idit
AU - Harlev, Avi
AU - Sergienko, Ruslan
AU - Landau, Daniella
AU - Sheiner, Eyal
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Objective Studies have questioned the long-term health effects of offspring conceived after fertility treatments. Methods We aimed to evaluate whether an association exists between mode of conception (in vitro fertilization, ovulation induction, or spontaneous pregnancy) and neoplasm risk (both benign and malignant tumors) among the offspring; we observed the offspring for up to 18 years. Study Design A population-based cohort analysis was performed that compared the risk for neoplasms among children (up to the age of 18 years) based on mode of conception. Neoplasm diagnoses were based on hospital records of the same single tertiary center in the region. All singletons born during from 1991–2013 and discharged alive were included in the study. Offspring with congenital malformations were excluded from the analysis. Kaplan-Meier survival curves were constructed to compare cumulative neoplasms incidence; multivariable survival analyses were used to control for confounders that included gestational age, pregnancy complications, and maternal factors. Results During the study period, 242,187 newborn infants met the inclusion criteria: 2603 (1.1%) were conceived after in vitro fertilization; 1721 (0.7%) were conceived after ovulation induction treatments, and 237,863 (98.3%) were conceived spontaneously. During the follow-up period (median, 10.55 years), 1498 neoplasms(0.6%) were diagnosed. Incidence density rate for neoplasms was higher among children conceived either after in vitro fertilization (1.5/1000 person years) or ovulation induction treatments (1.0/1000 person years), as compared with naturally conceived children (0.59/1000 person years; Kaplan-Meier log rank, P<.001). The association between in vitro fertilization and total pediatric neoplasms and the association between any fertility treatments and malignancies remained significant; we controlled for confounders such as gestational diabetes mellitus, hypertensive disorders, preterm birth, and maternal age (adjusted hazard ratio, 2.48; 95% confidence interval, 1.71–3.50; and adjusted hazard ratio, 1.96; 95% confidence interval, 1.14–3.36, for all neoplasms and all malignancies, respectively). Conclusion Children conceived after fertility treatments are at an increased risk for pediatric neoplasms.
AB - Objective Studies have questioned the long-term health effects of offspring conceived after fertility treatments. Methods We aimed to evaluate whether an association exists between mode of conception (in vitro fertilization, ovulation induction, or spontaneous pregnancy) and neoplasm risk (both benign and malignant tumors) among the offspring; we observed the offspring for up to 18 years. Study Design A population-based cohort analysis was performed that compared the risk for neoplasms among children (up to the age of 18 years) based on mode of conception. Neoplasm diagnoses were based on hospital records of the same single tertiary center in the region. All singletons born during from 1991–2013 and discharged alive were included in the study. Offspring with congenital malformations were excluded from the analysis. Kaplan-Meier survival curves were constructed to compare cumulative neoplasms incidence; multivariable survival analyses were used to control for confounders that included gestational age, pregnancy complications, and maternal factors. Results During the study period, 242,187 newborn infants met the inclusion criteria: 2603 (1.1%) were conceived after in vitro fertilization; 1721 (0.7%) were conceived after ovulation induction treatments, and 237,863 (98.3%) were conceived spontaneously. During the follow-up period (median, 10.55 years), 1498 neoplasms(0.6%) were diagnosed. Incidence density rate for neoplasms was higher among children conceived either after in vitro fertilization (1.5/1000 person years) or ovulation induction treatments (1.0/1000 person years), as compared with naturally conceived children (0.59/1000 person years; Kaplan-Meier log rank, P<.001). The association between in vitro fertilization and total pediatric neoplasms and the association between any fertility treatments and malignancies remained significant; we controlled for confounders such as gestational diabetes mellitus, hypertensive disorders, preterm birth, and maternal age (adjusted hazard ratio, 2.48; 95% confidence interval, 1.71–3.50; and adjusted hazard ratio, 1.96; 95% confidence interval, 1.14–3.36, for all neoplasms and all malignancies, respectively). Conclusion Children conceived after fertility treatments are at an increased risk for pediatric neoplasms.
KW - assisted reproduction technology
KW - childhood cancer
KW - fertility treatment
KW - in vitro fertilization
KW - ovulation induction
UR - http://www.scopus.com/inward/record.url?scp=85019940278&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2017.01.015
DO - 10.1016/j.ajog.2017.01.015
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C2 - 28153657
AN - SCOPUS:85019940278
SN - 0002-9378
VL - 216
SP - 314.e1-314.e14
JO - American Journal of Obstetrics and Gynecology
JF - American Journal of Obstetrics and Gynecology
IS - 3
ER -