Mortality from infancy to adolescence in singleton children conceived from assisted reproductive techniques versus naturally conceived singletons in SwedenShow others and affiliations
2020 (English)In: Fertility and Sterility, ISSN 0015-0282, E-ISSN 1556-5653, Vol. 113, no 3, p. 524-532Article in journal (Refereed) Published
Abstract [en]
Objective: To assess infant (<1 year) and childhood (1-18 years) mortality in singletons conceived through assisted reproductive techniques (ART) versus naturally conceived singletons.
Design: Nationwide prospective study.
Setting: Sweden.
Patient(s): All singleton liveborn infants born from 1983 to 2012 in Sweden identified using the Medical Birth Register (N = 2,847,108), of whom 43,506 were conceived through ART treatments including in vitro fertilization with and without intracytoplasmic sperm injection.
Intervention(s): None.
Main Outcome Measures(s): Infant (<1 year) and childhood (1-18 years) mortality.
Result(s): Data on ART treatment and covariates were retrieved from population-based registers using the unique personal identity number assigned to all permanent residents in Sweden. Cox proportional hazards models estimated the hazard ratios (HRs) with 95% confidence intervals (CIs) as measures of association between ART treatments and death. The analyses were adjusted for maternal characteristics, infertility, child sex, and birth cohort and were restricted to individuals with complete information on covariates for fully adjusted analysis. Compared with naturally conceived singletons, higher infant mortality risks were seen in infants conceived through ART (adjusted HR 1.45; 95% CI, 1.19-1.77), especially after transfer of cryopreserved embryos (adjusted HR 2.30; 95% CI, 1.46-3.64). Early neonatal mortality risk (deaths during the first week) was increased in children born after transfer of blastocysts (HR 2.40; 95% CI, 1.05-5.48). No increased mortality risk was observed between the ages of 1 and 18 years.
Conclusion(s): Singletons conceived through ART had an increased risk of infant mortality from birth up to 1 year of life, predominantly in the early neonatal period and in pregnancies after transfer of frozen and thawed embryos. (C) 2019 by American Society for Reproductive Medicine.
Place, publisher, year, edition, pages
Elsevier, 2020. Vol. 113, no 3, p. 524-532
Keywords [en]
Assisted reproductive techniques, childhood mortality, infant mortality, infertility, live birth, neonatal mortality, pregnancy
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:oru:diva-81127DOI: 10.1016/j.fertnstert.2019.10.018ISI: 000520127300009PubMedID: 32081362Scopus ID: 2-s2.0-85079773371OAI: oai:DiVA.org:oru-81127DiVA, id: diva2:1423318
Funder
Swedish Research Council, K2011-69X-21871-01-6Swedish Research Council, SIMSAM 340-2013-5867The Karolinska Institutet's Research FoundationStockholm County Council
Note
Funding Agencies:
European Union (EU) 259679
Strategic Research Program in Epidemiology Young Scholar Awards
2020-04-142020-04-142021-01-19Bibliographically approved