Hvidtjørn Dorte, Schieve Laura, Schendel Diana, Jacobsson Bo, Svaerke Claus, Thorsen Poul
NANEA, Institute of Public Health, Department of Epidemiology, University of Aarhus, Paludan-Müllers vej 17, 8000 Aarhus C, Denmark.
Arch Pediatr Adolesc Med. 2009 Jan;163(1):72-83. doi: 10.1001/archpediatrics.2008.507.
To assess the existing evidence of associations between assisted conception and cerebral palsy (CP), autism spectrum disorders (ASD), and developmental delay.
Forty-one studies identified in a systematical PubMed and Excerpta Medica Database (EMBASE) search for articles published from January 1, 1996, to April 1, 2008.
Studies written in English comparing children born after assisted conception with children born after natural conception assessing CP, ASD, and developmental delay, based on original data with a follow-up of 1 year or more. Main Exposures In vitro fertilization (IVF) with or without intracytoplasmic sperm injection or ovulation induction with or without subsequent intrauterine insemination.
Cerebral palsy, ASD, and developmental delay.
Nine CP studies showed that children born after IVF had an increased risk of CP associated with preterm delivery. In our meta-analysis including 19 462 children exposed to IVF, we estimated a crude odds ratio of 2.18 (95% confidence interval, 1.71-2.77). Eight ASD studies and 30 studies on developmental delay showed inconsistent results. No studies assessed the risk of CP, ASD, or developmental delay in children born after ovulation induction exclusively.
Methodological problems were revealed in the identified studies, and the gaps in our knowledge about the long-term outcomes of children born after assisted conception are considerable, including a lack of information on the long-term consequences of ovulation induction. Possible associations with ASD and developmental delay need assessment in larger studies. Studies on assisted conception and CP from countries outside of Scandinavia are needed, including detailed information on time to pregnancy, underlying cause of infertility, and type of IVF treatment.
评估辅助受孕与脑瘫（CP）、自闭症谱系障碍（ASD）和发育迟缓之间关联的现有证据。
通过对PubMed和医学文摘数据库（EMBASE）进行系统检索，确定了41项研究，这些研究发表于1996年1月1日至2008年4月1日期间。
基于原始数据且随访1年或更长时间，用英文撰写的比较辅助受孕后出生儿童与自然受孕后出生儿童的研究，评估CP、ASD和发育迟缓情况。主要暴露因素：有或无卵胞浆内单精子注射的体外受精（IVF），有或无后续宫内人工授精的排卵诱导。
脑瘫、ASD和发育迟缓。
9项关于CP的研究表明，IVF后出生的儿童患CP的风险增加，且与早产有关。在我们纳入19462名接受IVF儿童的荟萃分析中，我们估计粗比值比为2.18（95%置信区间，1.71 - 2.77）。8项关于ASD的研究和30项关于发育迟缓的研究结果不一致。没有研究专门评估排卵诱导后出生儿童患CP、ASD或发育迟缓的风险。
在所确定的研究中发现了方法学问题，我们对辅助受孕后出生儿童的长期结局的认识存在相当大的差距，包括缺乏关于排卵诱导长期后果的信息。ASD和发育迟缓的可能关联需要在更大规模的研究中进行评估。需要来自斯堪的纳维亚半岛以外国家的关于辅助受孕和CP的研究，包括关于受孕时间、不孕潜在原因以及IVF治疗类型的详细信息。
