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Early Autism Spectrum Disorders in Children Born to Fertile, Subfertile, and ART-Treated Women

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Abstract

Introduction

We examined the prevalence of autism spectrum disorders (ASDs) in Massachusetts (MA) comparing children born via assisted reproductive technology (ART) and children born to women with indicators of subfertility but no ART (Subfertile), to children born to women with neither ART nor indicators of subfertility (Fertile). We assessed the direct, indirect, and total effects of ART and subfertility on ASD among singletons.

Methods

This study included 10,147 ART, 8072 Subfertile and 441,898 Fertile MA resident births from the MA Outcome Study of ART (MOSART) database linked with Early Intervention program participation data. ART included fresh in vitro fertilization (IVF), fresh intracytoplasmic sperm injection (ICSI), and frozen embryo transfer. We estimated the prevalence of ASD by fertility group. We used logistic regression to assess the natural direct effect (NDE), natural indirect effect (NIE) through preterm birth, and total effects of each fertility group on ASD.

Results

The NDE indicated that, compared to the Fertile group, the odds of ASD were not statistically higher in the ART (ORNDE 1.07; 95% CI 0.88–1.30), Subfertile (ORNDE 1.11; 95% CI 0.89–1.38), IVF (ORNDE 0.91; 95% CI 0.68–1.22), or ICSI (ORNDE 1.13; 95% CI 0.84–1.51) groups, even if the rate of preterm birth was the same across all groups. The total effect (product of NDE and NIE) was not significant for ART (ORTotal Effect 1.08; 95% CI 0.89–1.30), Subfertile (ORTotal Effect 1.11; 95% CI 0.89–1.38), IVF (ORTotal Effect 0.92; 95% CI 0.69–1.23), or ICSI (ORTotal Effect 1.13; 95% CI 0.84–1.52).

Conclusion

Compared to children born to Fertile women, children born to ART, ICSI, or IVF, or Subfertile women are not at increased risk of receiving an ASD diagnosis.

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Acknowledgements

The authors would like to thank SART Members for providing clinical information to the SART CORS database for use by patients and researchers. Without the efforts of SART Members, this research would not have been possible. The authors also want to thank Gabriela Kernan from the Massachusetts Department of Public Health for providing technical support around EI data acquisition. This work was supported by R01HD064595 and R01HD067270. The views expressed in this article are those of the authors and do not necessarily represent the official view of the National Institutes of Health or the Massachusetts Department of Public Health.

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Authors and Affiliations

  1. Massachusetts Department of Public Health, 250 Washington Street, 6th Floor, Boston, MA, 02108, USA

    Hafsatou Diop & Xiaohui Cui

  2. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA

    Howard Cabral & Daksha Gopal

  3. Obstetrics and Gynecology and Pathology, Dartmouth-Hitchcock, Lebanon, NH, USA

    Judy E. Stern

  4. Division of General Academic Pediatrics/Center for Child and Adolescent Health Research & Policy, MassGeneral Hospital for Children and Harvard Medical School, Boston, MA, USA

    Milton Kotelchuck

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  1. Hafsatou Diop
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  2. Howard Cabral
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  3. Daksha Gopal
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  4. Xiaohui Cui
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  6. Milton Kotelchuck
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Correspondence to Hafsatou Diop.

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Diop, H., Cabral, H., Gopal, D. et al. Early Autism Spectrum Disorders in Children Born to Fertile, Subfertile, and ART-Treated Women. Matern Child Health J 23, 1489–1499 (2019). https://doi.org/10.1007/s10995-019-02770-z

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