Division of Reproduction Medicine, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan.
Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
PLoS One. 2021 Sep 10;16(9):e0257268. doi: 10.1371/journal.pone.0257268. eCollection 2021.
To compare the risk of neurodevelopmental disorders in children conceived via intracytoplasmic sperm injection (ICSI) and those conceived naturally.
A population-based cohort study using data retrieved from the Taipei Medical University Research Database (TMURD) from January, 2004 to August, 2016. The data included maternal pregnancy history, perinatal history and developmental follow up of their babies up to 5 years of age. The study included 23885 children, of whom 23148 were naturally conceived and 737 were conceived via ICSI. Neurodevelopmental disorders defined by 21 ICD-9-CM codes.
Of the 23885 children enrolled for analysis, 2778 children were included for further subgrouping analysis after propensity matching to reduce bias from maternal factors. The single-birth group included 1752 naturally conceived (NC) children and 438 ICSI children. The multiple-birth group included 294 NC and 294 ICSI children. The risk of neurodevelopmental disorders was not increased for ICSI children in both groups (single birth: adjusted hazard ratio aHR = 0.70, 95% CI = 0.39-1.27, p = 0.243; multiple-birth group aHR = 0.77, 95% CI = 0.43-1.35, p = 0.853). In the single-birth group, multivariate analyses showed that male sex (aHR = 1.81, 95% CI = 1.29-2.54, p < 0.001), and intensive care unit (ICU) admission (aHR = 3.10, 95% CI = 1.64-5.86, p < 0.001) were risk factors for neurodevelopmental disorders. In the multiple-birth group, multivariate analyses demonstrated that ICU admission (aHR = 3.58, 95% CI = 1.82-7.04, p < 0.001), was risk factor for neurodevelopmental disorders.
Our study indicated that the use of ICSI does not associated with higher risk of neurodevelopmental disorders in the offspring. But male sex, and ICU admission do have increased risk of neurodevelopmental disorders. However, long term follow up of this cohort on health outcomes in adolescence and adulthood will strengthen the conclusions that ICSI is safe regarding offspring long term outcome.
比较经胞浆内单精子注射（ICSI）和自然受孕儿童神经发育障碍的风险。
这是一项基于人群的队列研究，使用 2004 年 1 月至 2016 年 8 月从台北医学大学研究数据库（TMURD）中获取的数据。该数据包括母亲的妊娠史、围产期史以及其婴儿在 5 岁之前的发育随访情况。该研究共纳入 23885 名儿童，其中 23148 名自然受孕，737 名通过 ICSI 受孕。神经发育障碍由 21 个 ICD-9-CM 编码定义。
在纳入分析的 23885 名儿童中，对 2778 名儿童进行了倾向评分匹配，以减少母亲因素造成的偏倚，进一步进行亚组分析。单胎组包括 1752 名自然受孕（NC）儿童和 438 名 ICSI 儿童。多胎组包括 294 名 NC 儿童和 294 名 ICSI 儿童。两组中 ICSI 儿童的神经发育障碍风险均无增加（单胎组：校正后的危险比 aHR = 0.70，95%CI = 0.39-1.27，p = 0.243；多胎组 aHR = 0.77，95%CI = 0.43-1.35，p = 0.853）。在单胎组中，多变量分析显示男性（aHR = 1.81，95%CI = 1.29-2.54，p < 0.001）和重症监护病房（ICU）入住（aHR = 3.10，95%CI = 1.64-5.86，p < 0.001）是神经发育障碍的危险因素。在多胎组中，多变量分析表明 ICU 入住（aHR = 3.58，95%CI = 1.82-7.04，p < 0.001）是神经发育障碍的危险因素。
我们的研究表明，ICSI 的使用与后代神经发育障碍的风险增加无关。但是，男性和 ICU 入住会增加神经发育障碍的风险。然而，对这一队列的长期随访，了解其在青少年和成年期的健康结局，将加强 ICSI 对后代长期结局是安全的结论。
