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Original Investigation |

Examining Infertility Treatment and Early Childhood Development in the Upstate KIDS Study

Edwina H. Yeung, PhD, ScM1; Rajeshwari Sundaram, PhD1; Erin M. Bell, PhD2,3; Charlotte Druschel, MD, MPH2,4; Christopher Kus, MD5; Akhgar Ghassabian, MD, PhD1; Scott Bello, MD, MPH6; Yunlong Xie, PhD1; Germaine M. Buck Louis, PhD, MS1
[+] Author Affiliations
1Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
2Department of Environmental Health Sciences, University at Albany School of Public Health, Albany, New York
3Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, New York
4Bureau of Environmental and Occupational Epidemiology, Center for Environmental Health, New York State Department of Health, Albany
5Division of Family Health, New York State Department of Health, Albany
6Developmental Pediatrics, CapitalCare Pediatrics–Troy, Troy, New York
JAMA Pediatr. 2016;170(3):251-258. doi:10.1001/jamapediatrics.2015.4164.
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Importance  An increasing percentage of births are conceived with assisted reproductive technology (ART) and other infertility treatment. Despite findings that such treatments may be associated with diminished gestation and birth size, scarce data exist regarding infertility treatments and children’s development in the United States.

Objective  To assess the use and type of infertility treatment in relation to children’s development through age 36 months.

Design, Setting, and Participants  Prospective cohort study (conducted 2008-2014) that sampled based on infertility treatment and plurality. Included in the study were infants born between 2008 and 2010 in New York state (excluding New York City) whose parents completed developmental screening instruments through 36 months of age. A total of 4824 mothers (97% of 4989) completed 1 or more developmental screening instruments for 5841 children, including 1830 conceived with infertility treatment and 2074 twins.

Exposures  Maternal self-report of any infertility treatment was further categorized into ART and ovulation induction/intrauterine insemination. Assisted reproductive technology use was previously validated by linkage with the Society for Assisted Reproductive Technology–Clinical Outcome Reporting System.

Main Outcomes and Measures  Five developmental domains (fine motor, gross motor, communication, personal-social functioning, and problem-solving ability), as measured by the parental completion of the Ages and Stages Questionnaires at 4, 8, 12, 18, 24, 30, and 36 months of age. Generalized linear mixed modeling techniques estimated adjusted odds ratios (aORs) and 95% CIs for use and type of infertility treatment in relation to failing a developmental domain. Data were stratified by plurality and weighted for the sampling scheme.

Results  There were 1422 mothers (29.5%; mean [SD], age, 34.1 [5.2] years) who underwent infertility treatment. Infertility treatment was not associated with risk of their children failing any developmental domain (aOR, 1.33; 95% CI, 0.94-1.89). Assisted reproductive technology was associated with increased risk for failing any developmental domain but only when singletons and twins were evaluated together (aOR, 1.81; 95% CI, 1.21-2.72). Adjustment for birth weight further attenuated this estimate (aOR, 1.26; 95% CI, 0.82-1.93). After stratifying by plurality, type of treatment also was not significantly associated with failing any developmental domain for ovulation induction/intrauterine insemination (aOR, 1.00; 95% CI, 0.57-1.77 for singletons and aOR, 1.30; 95% CI, 0.76-2.21 for twins) or ART (aOR, 1.38; 95% CI, 0.78-2.43 for singletons and aOR, 1.58; 95% CI, 0.94-2.65 for twins).

Conclusions and Relevance  After considering plurality, children’s development through age 3 years was similar irrespective of infertility treatment or specific type. To our knowledge, these findings are among the first to focus on non-ART treatments in the United States.

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Figure.
Probabilities of Failing the Ages and Stages Questionnaire (ASQ) From 4 to 36 Months by Infertility Treatment Status and Plurality

The probabilities of failing any ASQ domain and of the specific domains are shown. The longitudinal crude probabilities of failure by infertility treatment status for all children and stratified by plurality were estimated by generalized linear mixed-effects models using ASQ data from 4 to 36 months in the Upstate KIDS Study.

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