Fertility treatments and gastrointestinal morbidity of the offspring. (May 2020) - Shachor, Noga
Abstract: Background: Prevalence of pregnancies conceived following fertility treatments is high worldwide. While the impact of fertility treatments on short-term perinatal outcome is well established, long-term consequences are yet to be determined. Objective: To study the association between mode of conception and long-term gastrointestinal morbidity among children born following fertility treatments. Study design: A population-based cohort analysis including all singleton deliveries occurring between 1991 and 2014 at a single regional tertiary medical center was performed. Fetuses with congenital malformations were excluded. A comparison was performed between children delivered following IVF, OI and spontaneous pregnancies. Hospitalizations up to the age of 18 years involving gastrointestinal morbidity were evaluated. Kaplan-Meier survival curve was used to compare cumulative morbidity incidence. A Cox regression model was used to control for confounders. Results: During the study period 242, 187 singleton deliveries met the inclusion criteria; 1.1% following IVF (n = 2603), and 0.7% following OI (n = 1721). Hospitalization rates involving gastrointestinal morbidity were significantly higher in children conceived following IVF and OI (5.7%, 7.1% respectively) as compared with children conceived spontaneously (5.4%; p = 0.005). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of gastrointestinal morbidity following IVF and OI (log rank p = 0.001). Using a Cox proportional hazards model, controlling for maternal age, preterm delivery, birthweight, maternal diabetes and hypertensive disorders in pregnancy, IVF (adjusted HR = 1.27, CI 1.08–1.50, p = 0.004), was noted as an independent risk factor for long-term pediatric gastrointestinal morbidity. Conclusion: Singletons conceived by IVF appear to be at an increased risk for long-term gastrointestinal morbidity. Highlights: Fertility treatments are common procedures worldwide. The short-term complications of those treatments are well established. The long-term complications are yet to be determined, specifically gastrointestinal (GI) related ones. This study is the result of 24 years of data gathering. According to that data singletons conceived by IVF appear to be at an increased risk for long-term GI morbidity. These disorders might be the result of epigenetic dysregulation, occurring during ART and might be a consequence of them. [1–37 ] These results offer complementary information provided to parturient patients with pregnancies conceived via IVF.