Klemetti Reija, Sevón Tiina, Gissler Mika, Hemminki Elina
Health Services Research, National Research and Development Centre for Welfare and Health, Helsinki, Finland.
Pediatrics. 2006 Nov;118(5):1819-27. doi: 10.1542/peds.2006-0735.
The purpose of this study was to use nationwide registries to examine the health of children up to 4 years of age who were born as a result of in vitro fertilization.
Children born after in vitro fertilization (N = 4559) from 1996 to 1999 were monitored until 2003. Two control groups were selected from the Finnish Medical Birth Register as follows: all other children (excluding children born after ovulation induction) from the same period (N = 190,398, for study of perinatal health and hospitalizations) and a random sample of those children (n = 26,877, for study of health-related benefits). Mortality rates and odds ratios for perinatal outcomes, hospitalizations, health-related benefits, and long-term medication use were calculated.
Although the health of most in vitro fertilization children was good, such children had more health problems than other children. A total of 35.7% of in vitro fertilization children and 2.2% of control children were multiple births, and the health of multiple births was worse than that of singletons. Perinatal outcomes of in vitro fertilization children were worse and hospital episodes were more common than among control children. Risks for cerebral palsy and psychological and developmental disorders were increased. Among in vitro fertilization singletons, worse results for perinatal outcomes and hospitalizations, but no increased risk for specific diseases, were found. The health of in vitro fertilization multiple births was comparable to the health of control multiple births.
Reducing the number of transferred embryos would improve the health of in vitro fertilization children. Additional studies are needed to explain the poorer health of in vitro fertilization singletons, as well as follow-up studies to examine the health of in vitro fertilization children from 4 years onward.
本研究旨在利用全国性登记系统,调查通过体外受精出生的4岁以下儿童的健康状况。
对1996年至1999年期间体外受精出生的儿童(N = 4559名)进行监测,直至2003年。从芬兰医学出生登记处选取两个对照组如下:同一时期的所有其他儿童(不包括诱导排卵后出生的儿童)(N = 190398名,用于围产期健康和住院情况研究)以及这些儿童的随机样本(n = 26877名,用于健康相关福利研究)。计算围产期结局、住院情况、健康相关福利和长期用药的死亡率及比值比。
尽管大多数体外受精儿童健康状况良好,但此类儿童比其他儿童有更多健康问题。体外受精儿童中有35.7%为多胞胎,对照组儿童中有2.2%为多胞胎,多胞胎的健康状况比单胞胎差。体外受精儿童的围产期结局更差,住院次数比对照组儿童更常见。脑瘫以及心理和发育障碍的风险增加。在体外受精单胞胎中,发现围产期结局和住院情况较差,但特定疾病风险未增加。体外受精多胞胎的健康状况与对照多胞胎相当。
减少移植胚胎数量将改善体外受精儿童的健康状况。需要进一步研究来解释体外受精单胞胎健康状况较差的原因,以及对4岁及以上体外受精儿童健康状况进行随访研究。