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CME / CE

Does Developmental Performance Differ for Children Conceived by IVF?

  • Authors: News Author: Damian McNamara; CME Author: Laurie Barclay, MD
  • CME / CE Released: 3/17/2023
  • Valid for credit through: 3/17/2024, 11:59 PM EST
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)

    Physician Assistant - 0.25 AAPA hour(s) of Category I credit

    IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit

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Target Audience and Goal Statement

This activity is intended for obstetricians/gynecologists/women's health clinicians, family medicine/primary care clinicians, pediatricians, public health and prevention officials, nurses, pharmacists, physician assistants, and other members of the healthcare team who care for women undergoing in vitro fertilization (IVF) and their offspring.

The goal of this activity is for learners to be better able to describe the causal effect of IVF conception on primary school-age childhood developmental and educational outcomes compared with outcomes after spontaneous conception.

Upon completion of this activity, participants will:

  • Describe the causal effect of IVF conception on primary school-age childhood developmental and educational outcomes compared with outcomes after spontaneous conception
  • Identify clinical and public health implications of the causal effect of IVF conception on primary school-age childhood developmental and educational outcomes compared with outcomes after spontaneous conception
  • Outline implications for the healthcare team


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News Author

  • Damian McNamara

    Freelance writer, Medscape

    Disclosures

    Damian McNamara has no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Laurie Barclay, MD, has no relevant financial relationships.

Editor/Nurse Planner  ​

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Stephanie Corder, ND, RN, CHCP, has no relevant financial relationships. ​

Compliance Reviewer   ​

  • Yaisanet Oyola, MD

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Yaisanet Oyola, MD, has no relevant financial relationships.

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This activity has been peer reviewed and the reviewer has no relevant financial relationships.


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CME / CE

Does Developmental Performance Differ for Children Conceived by IVF?

Authors: News Author: Damian McNamara; CME Author: Laurie Barclay, MDFaculty and Disclosures

CME / CE Released: 3/17/2023

Valid for credit through: 3/17/2024, 11:59 PM EST

processing....

Clinical Context

Since the first successful in vitro fertilization (IVF) birth in 1978, > 8 million babies globally have been born following IVF conception. Studies of long-term IVF outcomes have reported conflicting results.

Health and sociodemographic factors differ between parents of IVF-conceived and spontaneously conceived children. In particular, increased maternal age and higher education are linked with use of fertility treatment and with better early childhood outcomes Such factors must be considered when evaluating the association between mode of conception and childhood outcomes.

Study Synopsis and Perspective

In vitro fertilization has been around long enough that researchers can now compare developmental and academic achievements between these children and peers at school age. 

Amber Kennedy, MBBS, and colleagues did just that. They found little difference in these milestones between a total of 11,059 IVF-conceived children and 401,654 spontaneously conceived children in a new study.

"Parents considering IVF and health care professionals can be reassured that the school age developmental and educational outcomes of IVF-conceived children are equivalent to their peers," said Kennedy, lead author and obstetrician and gynecologist at Mercy Hospital for Women at the University of Melbourne, Australia. 

The findings were published January 24 in the journal PLOS Medicine.

"Overall, we know that children born through IVF are doing fine in terms of health, but also emotionally and cognitively. So I wasn't surprised. I live in this world," said Ariadna Cymet Lanski, PsyD, chair of the American Society for Reproductive Medicine Mental Health Professional Group, who was not affiliated with the study.

Some previous researchers linked conception via IVF to an increased risk for congenital abnormalities, autism spectrum disorder, developmental delay, and intellectual disability.

Asked why the current study did not find increased risks, Kennedy said, "Our population included a relatively recent birth cohort, which may explain some differences from previous studies as IVF practices have evolved over time." 

An estimated 8 million people worldwide have been conceived through IVF since the first birth in 1978, the researchers said. In Australia, this has grown from 2% of births in the year 2000 to now nearly 5% or 1 in 20 live births, Kennedy said. "Consequently, it is important to understand the longer-term outcomes for this population of children."

Along with senior author Anthea Lindquist, MBBS, Kennedy and colleagues studied 585,659 single births in Victoria, Australia, between 2005 and 2014. They did not include multiple births such as twins or triplets.

The investigators compared 4697 children conceived via IVF and 168,503 others conceived spontaneously using a standard developmental measure, the Australian Early Developmental Census (AEDC). They also assessed 8976 children in the IVF group and 333,335 other children on a standard educational measure, the National Assessment Program-Literacy and Numeracy (NAPLAN).

For example, the developmental census measures developmental vulnerability. Kennedy and colleagues found a 0.3% difference in favor of IVF-conceived children, which statistically was no different than zero.

Similarly, the researchers reported that IVF conception had essentially no effect on overall literacy score, with an adjusted average difference of 0.03.

Lanski said the results should be reassuring for people considering IVF: "I can see the value of the study."

Not all IVF techniques are the same, and the researches want to take a deeper dive to evaluate any distinctions among them. For example, Kennedy said, "We plan to investigate the same school-aged outcomes after specific IVF-associated techniques." 

PLoS Med. 2023;20:e1004148.[1]

Study Highlights

  • The researchers used causal inference methods to analyze observational data in a way that emulates a target randomized controlled trial.
  • The study cohort comprised statewide linked maternal and childhood administrative data for 585,659 singleton infants conceived spontaneously or via IVF, born in Victoria, Australia, between 2005 and 2014, and who had school-age developmental and educational outcomes assessment.
  • Investigators assessed childhood developmental vulnerability at school entry (age 4-6 years) in 173,200 children using AEDC and defined it as < 10th percentile in ≥ 2 of 5 developmental domains (physical health and well-being, social competence, emotional maturity, language and cognitive skills, communication skills, and general knowledge).
  • They used NAPLAN (n = 342,311) to determine educational outcome at age 7 to 9 years using overall z scores across 5 domains (grammar and punctuation, reading, writing, spelling, and numeracy).
  • Researchers estimated population average causal effects using inverse probability weighting, with regression adjustment for sex at birth, age at assessment, language background other than English, socioeconomic status, maternal age, parity, and education.
  • Across the 2 outcome cohorts, there were 412,713 children, with linked records available for 4697 IVF-conceived cases and 168,503 control participants for AEDC, and 8976 cases and 333,335 control participants for NAPLAN.
  • Compared with spontaneously conceived children, children conceived via IVF had older, more highly educated parents, mothers with lower parity, and residence in areas with higher socioeconomic ranking and were less likely to be from non-English speaking backgrounds.
  • IVF-conception had no causal effect on risk for developmental vulnerability at school-entry (AEDC) compared with spontaneously conceived children (13.6% vs 13.9%), with adjusted risk difference of −0.3% (95% CI: −3.7%, 3.1%) and adjusted relative risk of 0.97 (95% CI: 0.77, 1.25).
  • There were no differences between IVF-conceived and spontaneously conceived children in adjusted risk difference for any of the individual AEDC domains.
  • At age 7 to 9 years, IVF conception had no causal effect on NAPLAN overall z score between IVF-conceived and spontaneously conceived children (adjusted mean difference 0.03 [95% CI: −0.018, 0.077]).
  • IVF-conceived children performed better, on average, in measures of writing than spontaneously conceived children (z score mean difference 0.068 [95% CI: 0.004, 0.132]), but this is unlikely to be clinically important.
  • In 4 of 5 domains (numeracy, reading, spelling, and writing), IVF-conceived children were less likely to be below the national minimum standard than spontaneously conceived children.
  • The investigators concluded that under the given causal assumptions, the school-age developmental and educational outcomes for children conceived by IVF are equivalent to those of spontaneously conceived children.
  • The causal effect of IVF conception on overall AEDC and NAPLAN z score was indistinguishable from zero.
  • These findings offer important reassurance for current and prospective parents and for clinicians and may be useful in providing informed consent and education to persons considering IVF and persons with children conceived via IVF.
  • Since the first successful IVF birth in 1978, > 8 million babies globally have been born after IVF conception.
  • In Australia, ~ 1 in 20 babies are born after IVF conception, more than double since the year 2000, when 2% of births resulted from IVF.
  • The relatively recent birth cohort may explain lower risks in this study compared with previous studies, as IVF practices have evolved over time, and now include blastocyst culture, vitrification, and single-embryo transfer.
  • The findings are therefore more generalizable to contemporary fertility practice than those of previous studies, and use of updated epidemiological and statistical methods ensures a causal interpretation of estimated effects.
  • Given differences in IVF techniques and procedures, future research should address the same school-aged outcomes after specific IVF-associated techniques.
  • Study limitations include use of observational data, potential unmeasured confounding, presence of missing data, and inclusion only of children attending school, limiting analysis to outcomes for liveborn children.

Clinical Implications

  • School-age developmental and educational outcomes for children conceived by IVF were equivalent to those of spontaneously conceived children, according to a causal inference approach used in a population-wide cohort study.
  • The findings are more generalizable to contemporary fertility practice than those of previous studies showing higher risks with IVF, and use of updated epidemiologic and statistical methods ensured a causal interpretation of estimated effects.
  • Implications for the Healthcare Team: The findings offer important reassurance for current and prospective parents and may be useful for team members when providing informed consent and education to persons considering IVF and persons with children conceived via IVF.

 

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