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Rios P, Herlemont P, Fauque P, Lacour B, Jouannet P, Weill A, Zureik M, Clavel J, Dray-Spira R. Medically Assisted Reproduction and Risk of Cancer Among Offspring. JAMA Netw Open 2024; 7:e249429. [PMID: 38696167 PMCID: PMC11066701 DOI: 10.1001/jamanetworkopen.2024.9429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/12/2024] [Indexed: 05/05/2024] Open
Abstract
Importance Cancer is a leading cause of death among children worldwide. Treatments used for medically assisted reproduction (MAR) are suspected risk factors because of their potential for epigenetic disturbance and associated congenital malformations. Objective To assess the risk of cancer, overall and by cancer type, among children born after MAR compared with children conceived naturally. Design, Setting, and Participants For this cohort study, the French National Mother-Child Register (EPI-MERES) was searched for all live births that occurred in France between January 1, 2010, and December 31, 2021 (and followed up until June 30, 2022). The EPI-MERES was built from comprehensive data of the French National Health Data System. Data analysis was performed from December 1, 2021, to June 30, 2023. Exposure Use of assisted reproduction technologies (ART), such as fresh embryo transfer (ET) or frozen ET (FET), and artificial insemination (AI). Main Outcomes and Measures The risk of cancer was compared, overall and by cancer type, among children born after fresh ET, FET, or AI and children conceived naturally, using Cox proportional hazards regression models adjusted for maternal and child characteristics at birth. Results This study included 8 526 306 children with a mean (SD) age of 6.4 (3.4) years; 51.2% were boys, 96.4% were singletons, 12.1% were small for gestational age at birth, and 3.1% had a congenital malformation. There were 260 236 children (3.1%) born after MAR, including 133 965 (1.6%) after fresh ET, 66 165 (0.8%) after FET, and 60 106 (0.7%) after AI. A total of 9256 case patients with cancer were identified over a median follow-up of 6.7 (IQR, 3.7-9.6) years; 165, 57, and 70 were born after fresh ET, FET, and AI, respectively. The overall risk of cancer did not differ between children conceived naturally and those born after fresh ET (hazard ratio [HR], 1.12 [95% CI, 0.96 to 1.31]), FET (HR, 1.02 [95% CI, 0.78 to 1.32]), or AI (HR, 1.09 [95% CI, 0.86 to 1.38]). However, the risk of acute lymphoblastic leukemia was higher among children born after FET (20 case patients; HR 1.61 [95% CI, 1.04 to 2.50]; risk difference [RD], 23.2 [95% CI, 1.5 to 57.0] per million person-years) compared with children conceived naturally. Moreover, among children born between 2010 and 2015, the risk of leukemia was higher among children born after fresh ET (45 case patients; HR, 1.42 [95% CI, 1.06 to 1.92]; adjusted RD, 19.7 [95% CI, 2.8 to 43.2] per million person-years). Conclusions and Relevance The findings of this cohort study suggest that children born after FET or fresh ET had an increased risk of leukemia compared with children conceived naturally. This risk, although resulting in a limited number of cases, needs to be monitored in view of the continuous increase in the use of ART.
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Affiliation(s)
- Paula Rios
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
- Epidemiology of Childhood and Adolescent Cancers, Centre for Research in Epidemiology and Statistics, French National Institute for Health and Medical Research (INSERM) Joint Research Unit (UMR) 1153, Université Paris-Cité, Paris, France
| | - Philippe Herlemont
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Patricia Fauque
- INSERM UMR 1231, Université Bourgogne Franche-Comté, Dijon, France
| | - Brigitte Lacour
- Epidemiology of Childhood and Adolescent Cancers, Centre for Research in Epidemiology and Statistics, French National Institute for Health and Medical Research (INSERM) Joint Research Unit (UMR) 1153, Université Paris-Cité, Paris, France
- French National Registry of Childhood Cancers, Assistance Publique–Hôpitaux de Paris, Centre Hospitalier Régional Universitaire (CHU) Paul Brousse, Villejuif, France
- French National Registry of Childhood Solid Tumours, CHU de Nancy, Nancy, France
| | | | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Jacqueline Clavel
- Epidemiology of Childhood and Adolescent Cancers, Centre for Research in Epidemiology and Statistics, French National Institute for Health and Medical Research (INSERM) Joint Research Unit (UMR) 1153, Université Paris-Cité, Paris, France
- French National Registry of Childhood Cancers, Assistance Publique–Hôpitaux de Paris, Centre Hospitalier Régional Universitaire (CHU) Paul Brousse, Villejuif, France
- French National Registry of Childhood Solid Tumours, CHU de Nancy, Nancy, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
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Matsuo S, Ushida T, Tano S, Imai K, Yoshida S, Yamashita M, Kajiyama H, Kotani T. Sex-specific differences in head circumference of term singletons after assisted reproductive technology: a multicentre study in Japan. Reprod Biomed Online 2023; 47:103331. [PMID: 37820465 DOI: 10.1016/j.rbmo.2023.103331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/15/2023] [Accepted: 08/03/2023] [Indexed: 10/13/2023]
Abstract
RESEARCH QUESTION Does fertility treatment, specifically assisted reproductive technology (ART), affect head circumference in term singletons? DESIGN A total of 32,651 women who delivered at term at 12 maternity hospitals in Japan between 2010 and 2018 were included in the analysis; of these, 1941 (5.9%) and 2984 (9.1%) women conceived through ART and non-ART fertility treatments (timed intercourse, ovulation induction or artificial insemination), respectively. The study evaluated the adjusted odds ratios of head circumference ≥90th percentile stratified by infant sex and type of ART procedure after adjusting for covariates, with natural conception as the reference group. RESULTS ART significantly increased the risk of head circumference ≥90th percentile (adjusted odds ratio 1.56 [95% confidence interval 1.25-1.96]), whereas non-ART fertility treatment did not increase the risk (1.14 [0.92-1.42]). This increased risk of head circumference ≥90th percentile was observed exclusively in male neonates (1.73 [1.33-2.26]) and not in female neonates (1.18 [0.76-1.85]) in the ART group. Frozen embryo transfer (FET), FET in a hormone replacement cycle (HRC-FET) and blastocyst-stage embryo transfer were significantly associated with head circumference ≥90th percentile (1.60 [1.26-2.02], 1.70 [1.30-2.22] and 1.72 [1.33-2.24], respectively). CONCLUSIONS The use of ART, particularly FET, HRC-FET or blastocyst-stage embryo transfer, was linked with a heightened risk of head circumference ≥90th percentile compared with non-ART fertility treatment or natural conception. The increased risk was observed only in male neonates.
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Affiliation(s)
- Seiko Matsuo
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan; Division of Reproduction and Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Showa-ku, Nagoya, Japan.
| | - Sho Tano
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Shigeru Yoshida
- Kishokai Medical Corporation, Nishiki, Naka Ward, Nagoya, Japan
| | | | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan; Division of Reproduction and Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Showa-ku, Nagoya, Japan
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Nemes K, Benesch M, Kolarova J, Johann P, Hasselblatt M, Thomas C, Bens S, Glaser S, Ammerpohl O, Liaugaudiene O, Sadeghipour A, von der Weid N, Schmid I, Gidding C, Erdreich-Epstein A, Khurana C, Ebetsberger-Dachs G, Lemmer A, Khatib Z, Hernández Marqués C, Pears J, Quehenberger F, Kordes U, Vokuhl C, Gerss J, Schwarz H, Bison B, Biegel JA, Siebert R, Frühwald MC. Rhabdoid tumors in patients conceived following ART: is there an association? Hum Reprod 2023; 38:2028-2038. [PMID: 37553222 DOI: 10.1093/humrep/dead154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/14/2023] [Indexed: 08/10/2023] Open
Abstract
STUDY QUESTION In children affected by rhabdoid tumors (RT), are there clinical, therapeutic, and/or (epi-)genetic differences between those conceived following ART compared to those conceived without ART? SUMMARY ANSWER We detected a significantly elevated female predominance, and a lower median age at diagnosis, of children with RT conceived following ART (RT_ART) as compared to other children with RT. WHAT IS KNOWN ALREADY Anecdotal evidence suggests an association of ART with RT. STUDY DESIGN, SIZE, DURATION This was a multi-institutional retrospective survey. Children with RT conceived by ART were identified in our EU-RHAB database (n = 11/311 children diagnosed between January 2010 and January 2018) and outside the EU-RHAB database (n = 3) from nine different countries. A population-representative German EU-RHAB control cohort of children with RTs conceived without ART (n = 211) (EU-RHAB control cohort) during the same time period was used as a control cohort for clinical, therapeutic, and survival analyses. The median follow-up time was 11.5 months (range 0-120 months) for children with RT_ART and 18.5 months (range 0-153 months) for the EU-RHAB control cohort. PARTICIPANTS/MATERIALS, SETTING, METHODS We analyzed 14 children with RT_ART diagnosed from January 2010 to January 2018. We examined tumors and matching blood samples for SMARCB1 mutations and copy number alterations using FISH, multiplex ligation-dependent probe amplification, and DNA sequencing. DNA methylation profiling of tumor and/or blood samples was performed using DNA methylation arrays and compared to respective control cohorts of similar age (n = 53 tumors of children with RT conceived without ART, and n = 38 blood samples of children with no tumor born small for gestational age). MAIN RESULTS AND THE ROLE OF CHANCE The median age at diagnosis of 14 individuals with RT_ART was 9 months (range 0-66 months), significantly lower than the median age of patients with RT (n = 211) in the EU-RHAB control cohort (16 months (range 0-253), P = 0.03). A significant female predominance was observed in the RT_ART cohort (M:F ratio: 2:12 versus 116:95 in EU-RHAB control cohort, P = 0.004). Eight of 14 RT_ART patients were diagnosed with atypical teratoid rhabdoid tumor, three with extracranial, extrarenal malignant rhabdoid tumor, one with rhabdoid tumor of the kidney and two with synchronous tumors. The location of primary tumors did not differ significantly in the EU-RHAB control cohort (P = 0.27). Six of 14 RT_ART patients presented with metastases at diagnosis. Metastatic stage was not significantly different from that within the EU-RHAB control cohort (6/14 vs 88/211, P = 1). The incidence of pathogenic germline variants was five of the 12 tested RT_ART patients and, thus, not significantly different from the EU-RHAB control cohort (5/12 versus 36/183 tested, P = 0.35). The 5-year overall survival (OS) and event free survival (EFS) rates of RT_ART patients were 42.9 ± 13.2% and 21.4 ± 11%, respectively, and thus comparable to the EU-RHAB control cohort (OS 41.1 ± 3.5% and EFS 32.1 ± 3.3). We did not find other clinical, therapeutic, outcome factors distinguishing patients with RT_ART from children with RTs conceived without ART (EU-RHAB control cohort). DNA methylation analyses of 10 tumors (atypical teratoid RT = 6, extracranial, extrarenal malignant RT = 4) and six blood samples from RT_ART patients showed neither evidence of a general DNA methylation difference nor underlying imprinting defects, respectively, when compared to a control group (n = 53 RT samples of patients without ART, P = 0.51, n = 38 blood samples of patients born small for gestational age, P = 0.1205). LIMITATIONS, REASONS FOR CAUTION RTs are very rare malignancies and our results are based on a small number of children with RT_ART. WIDER IMPLICATIONS OF THE FINDINGS This cohort of patients with RT_ART demonstrated a marked female predominance, and a rather low median age at diagnosis even for RTs. Other clinical, treatment, outcome, and molecular factors did not differ from those conceived without ART (EU-RHAB control cohort) or reported in other series, and there was no evidence for imprinting defects. Long-term survival is achievable even in cases with pathogenic germline variants, metastatic disease at diagnosis, or relapse. The female preponderance among RT_ART patients is not yet understood and needs to be evaluated, ideally in larger international series. STUDY FUNDING/COMPETING INTEREST(S) M.C.F. is supported by the 'Deutsche Kinderkrebsstiftung' DKS 2020.10, by the 'Deutsche Forschungsgemeinschaft' DFG FR 1516/4-1 and by the Deutsche Krebshilfe 70113981. R.S. received grant support by Deutsche Krebshilfe 70114040 and for infrastructure by the KinderKrebsInitiative Buchholz/Holm-Seppensen. P.D.J. is supported by the Else-Kroener-Fresenius Stiftung and receives a Max-Eder scholarship from the Deutsche Krebshilfe. M.H. is supported by DFG (HA 3060/8-1) and IZKF Münster (Ha3/017/20). BB is supported by the 'Deutsche Kinderkrebsstiftung' DKS 2020.05. We declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Karolina Nemes
- Swabian Children's Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg, Augsburg, Germany
- Bavarian Cancer Research Center, Germany
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Julia Kolarova
- Institute of Human Genetics, Ulm University & Ulm University Medical Center, Ulm, Germany
| | - Pascal Johann
- Swabian Children's Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg, Augsburg, Germany
- Bavarian Cancer Research Center, Germany
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Christian Thomas
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Susanne Bens
- Institute of Human Genetics, Ulm University & Ulm University Medical Center, Ulm, Germany
| | - Selina Glaser
- Institute of Human Genetics, Ulm University & Ulm University Medical Center, Ulm, Germany
| | - Ole Ammerpohl
- Institute of Human Genetics, Ulm University & Ulm University Medical Center, Ulm, Germany
| | - Olga Liaugaudiene
- Department of Genetics and Molecular Medicine, Hospital of Lithuanian University of Health Sciences, Kauno Klinikos, Kaunas, Lithuania
| | - Alireza Sadeghipour
- Department of Pathology, Rasoul Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
| | - Nicolas von der Weid
- Department of Pediatric Hematology and Oncology, University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Irene Schmid
- Bavarian Cancer Research Center, Germany
- Department of Pediatric Hematology and Oncology, Dr. von Haunersches Kinderspital, München, Germany
| | - Corrie Gidding
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Anat Erdreich-Epstein
- Departments of Pediatrics and Pathology, Cancer and Blood Diseases Institute, Children's Hospital Los Angeles and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Claudia Khurana
- Children's Center, Evangelisches Krankenhaus Bielefeld, Bielefeld, Germany
| | | | - Andreas Lemmer
- Children's Hospital, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Ziad Khatib
- Department of Pediatric Hematology and Oncology, Miami Children's Hospital, Miami, FL, USA
| | | | - Jane Pears
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Franz Quehenberger
- Institute for Medical Statistics, Medical University of Graz, Graz, Austria
| | - Uwe Kordes
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Vokuhl
- Section of Pediatric Pathology, Department of Pathology, University Hospital Bonn, Bonn, Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Heike Schwarz
- Bavarian Cancer Research Center, Germany
- Diagnostic and Interventional Radiology, University Medical Center Augsburg, Augsburg, Germany
| | - Brigitte Bison
- Bavarian Cancer Research Center, Germany
- Faculty of Medicine, Diagnostic and Interventional Neuroradiology, Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, University of Augsburg, Augsburg, Germany
| | - Jaclyn A Biegel
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University & Ulm University Medical Center, Ulm, Germany
| | - Michael C Frühwald
- Swabian Children's Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg, Augsburg, Germany
- Bavarian Cancer Research Center, Germany
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Wiedermannova H, Mudry P, Pavlicek J, Tomaskova H, Hladikova A, Palova H, Vesela P, Slaby O, Sterba J. Risk factors for tumors or leukemia development in the first two years of life. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023; 167:246-253. [PMID: 35147139 DOI: 10.5507/bp.2022.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine the incidence of neoplastic diseases and associated risk factors in the early stages of life. METHODS Data were retrospectively assessed in 730,000 live births between 2000 and 2019. The occurrence of tumors was monitored in the neonatal, infant (1-12 months), and toddler (13-24 months) periods. Risk factors were divided into demographic, internal, and environmental factors. The control group consisted of subjects in the same age category without oncological diseases. RESULTS A total of 452 neoplastic diseases were diagnosed in the study sample. In total, 24% (110/452) manifested during the neonatal period, 45% (203/452) in infants, and 31% (139/452) at the age of 13-24 months. Any genetic disease (OR 26.68; 95% CI 7.64-93.12) and medications used by the mother (OR 3.07; 95% CI 1.32-7.15) were identified as risk factors. Without adjustment for all factors, asphyxia in the first minute, a younger age of the mother, lower pregnancy, and the presence of a congenital defect manifested themselves as risk factors. CONCLUSIONS The highest risk factors for the development of early childhood tumors were identified as with medications used by the mother before or during pregnancy and genetic diseases.
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Affiliation(s)
- Hana Wiedermannova
- Department of Neonatology, University Hospital Ostrava, Ostrava, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Peter Mudry
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Pediatric Oncology, University Hospital Brno, Brno, Czech Republic
- ICRC, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Jan Pavlicek
- Department of Pediatrics and Prenatal Cardiology, University Hospital Ostrava, Ostrava, Czech Republic
- Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Hana Tomaskova
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Andrea Hladikova
- Department of Medical Genetics, University Hospital of Ostrava, Ostrava, Czech Republic
| | - Hana Palova
- CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Petra Vesela
- CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Ondrej Slaby
- CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jaroslav Sterba
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Pediatric Oncology, University Hospital Brno, Brno, Czech Republic
- ICRC, St. Anne's University Hospital Brno, Brno, Czech Republic
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Spaan M, Pontesilli M, van den Belt-Dusebout AW, Burger CW, van den Heuvel-Eibrink MM, Ravelli ACJ, Goddijn M, Lambalk CB, Roseboom TJ, van Leeuwen FE. Cancer risk in children, adolescents, and young adults conceived by ART in 1983-2011. Hum Reprod Open 2023; 2023:hoad027. [PMID: 37346246 PMCID: PMC10279651 DOI: 10.1093/hropen/hoad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/19/2023] [Indexed: 06/23/2023] Open
Abstract
STUDY QUESTION Do children, adolescents, and young adults born after ART, including IVF, ICSI and frozen-thawed embryo transfer (FET), have an increased risk of cancer compared with children born to subfertile couples not conceived by ART and children from the general population? SUMMARY ANSWER After a median follow-up of 18 years, the overall cancer risk was not increased in children conceived by ART, but a slight risk increase was observed in children conceived after ICSI. WHAT IS KNOWN ALREADY There is growing evidence that ART procedures could perturb epigenetic processes during the pre-implantation period and influence long-term health. Recent studies showed (non-)significantly increased cancer risks after ICSI and FET, but not after IVF. STUDY DESIGN SIZE DURATION A nationwide historical cohort study with prospective follow-up was carried out, including all live-born offspring from women treated with ART between 1983 and 2011 and subfertile women not treated with ART in one of the 13 Dutch IVF clinics and two fertility centers. PARTICIPANTS/MATERIALS SETTING METHODS Children were identified through the mothers' records in the Personal Records Database. Information on the conception method of each child was collected through the mother's medical record. In total, the cohort comprises 89 249 live-born children of subfertile couples, of whom 51 417 were conceived using ART and 37 832 were not (i.e. conceived naturally, through ovulation induction, or after IUI). Cancer incidence was ascertained through linkage with the Netherlands Cancer Registry for the period 1989-2019. Cancer risk in children conceived using ART was compared with risk in children born to subfertile couples but not conceived by ART (hazard ratio (HR)) and children from the general population (standardized incidence ratios (SIRs)). MAIN RESULTS AND THE ROLE OF CHANCE In total, 358 cancers were observed after a median follow-up of 18 years. Overall cancer risk was not increased in children conceived using ART, when compared with the general population (SIR = 0.96, 95% CI = 0.81-1.12) or with children from subfertile couples not conceived by ART (HR = 1.06, 95% CI = 0.84-1.33). Compared with children from subfertile couples not conceived by ART, the use of IVF or FET was not associated with increased cancer risk, but ICSI was associated with a slight risk increase (HR = 1.58, 95% CI = 1.08-2.31). Risk of cancer after ART did not increase at older ages (≥18 years, HR = 1.26, 95% CI = 0.88-1.81) compared to cancer risk in children not conceived by ART. LIMITATIONS REASONS FOR CAUTION The observed increased risk among children conceived using ICSI must be interpreted with caution owing to the small number of cases. WIDER IMPLICATIONS OF THE FINDINGS After a median follow-up of 18 years, children conceived using ART do not have an increased overall cancer risk. Many large studies with prolonged follow-up are needed to investigate cancer risk in (young) adults conceived by different types of ART. In addition, international pooling of studies is recommended to provide sufficient power to study risk of specific cancer sites after ART. STUDY FUNDING/COMPETING INTERESTS This work was supported by The Dutch Cancer Society (NKI 2006-3631) that funded the OMEGA-women's cohort, Children Cancer Free (KIKA; 147) that funded the OMEGA-I-II offspring cohort. The OMEGA-III offspring cohort was supported by a Postdoc Stipend of Amsterdam Reproduction & Development, and the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD088393. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Mandy Spaan
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Martina Pontesilli
- Department of Obstetrics and Gynecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Curt W Burger
- Department of Gynecologic Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Anita C J Ravelli
- Department of Obstetrics and Gynecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Mariëtte Goddijn
- Centre for Reproductive Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis B Lambalk
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Centre for Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tessa J Roseboom
- Department of Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Shabtai T, Sheiner E, Wainstock T, Raziel A, Kessous R. Infertility Treatments Resulting in Twin Pregnancy: Does It Increase the Risk for Future Childhood Malignancy. J Clin Med 2023; 12:jcm12113728. [PMID: 37297923 DOI: 10.3390/jcm12113728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Background: Controversy exists in the literature regarding the possible association between infertility treatments in singleton pregnancies and long-term risk for childhood malignancy. Data regarding infertility treatments in twins and long-term childhood malignancies are scarce. Objective: We sought to investigate whether twins conceived following infertility treatments are at an increased risk for childhood malignancy. Study design: A population-based retrospective cohort study, comparing the risk for future childhood malignancy in twins conceived by infertility treatments (in vitro fertilization and ovulation induction) and those who were conceived spontaneously. Deliveries occurred between the years 1991 and 2021 in a tertiary medical center. A Kaplan-Meier survival curve was used to compare the cumulative incidence of childhood malignancies, and a Cox proportional hazards model was constructed to control for confounders. Results: During the study period, 11,986 twins met the inclusion criteria; 2910 (24.3%) were born following infertility treatments. No statistically significant differences were noted between the groups comparing the rate (per 1000) of childhood malignancies (2.0 in the infertility treatments group vs. 2.2 in the comparison group, OR 1.04, 95% CI 0.41-2.62; p = 0.93). Likewise, the cumulative incidence over time was comparable between the groups (log-rank test, p = 0.87). In a Cox regression model, controlling for maternal and gestational age, no significant differences in childhood malignancies were noted between the groups (adjusted HR = 0.82, 95% CI 0.49-1.39, p = 0.47). Conclusions: In our population, twins conceived following infertility treatments are not at an increased risk for childhood malignancies.
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Affiliation(s)
- Tal Shabtai
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer-Sheva 84101, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer-Sheva 84101, Israel
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Arie Raziel
- IVF Unit, Wolfson Medical Center, Affiliated to Tel-Aviv University, Tel Aviv 69978, Israel
| | - Roy Kessous
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer-Sheva 84101, Israel
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7
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Dangoni GD, Teixeira ACB, Vince CSC, Novak EM, Gimenez TM, Maschietto M, Odone Filho V, Krepischi ACV. LHX6 promoter hypermethylation in oncological pediatric patients conceived by IVF. J Dev Orig Health Dis 2023; 14:140-5. [PMID: 36154949 DOI: 10.1017/S2040174422000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The multifactorial etiology of pediatric cancer is poorly understood. Environmental factors occurring during embryogenesis can disrupt epigenetic signaling, resulting in several diseases after birth, including cancer. Associations between assisted reproductive technologies (ART), such as in vitro fertilization (IVF), and birth defects, imprinting disorders and other perinatal adverse events have been reported. IVF can result in methylation changes in the offspring, and a link with pediatric cancer has been suggested. In this study, we investigated the peripheral blood methylomes of 11 patients conceived by IVF who developed cancer in childhood. Methylation data of patients and paired sex/aged controls were obtained using the Infinium MethylationEPIC Kit (Illumina). We identified 25 differentially methylated regions (DMRs), 17 of them hypermethylated, and 8 hypomethylated in patients. The most significant DMR was a hypermethylated genomic segment located in the promoter region of LHX6, a transcription factor involved in the forebrain development and interneuron migration during embryogenesis. An additional control group was included to verify the LHX6 methylation status in children with similar cancers who were not conceived by ART. The higher LHX6 methylation levels in IVF patients compared to both control groups (healthy children and children conceived naturally who developed similar pediatric cancers), suggested that hypermethylation at the LHX6 promoter could be due to the IVF process and not secondary to the cancer itself. Further studies are required to evaluate this association and the potential role of LHX6 promoter hypermethylation for tumorigenesis.
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Luke B, Brown MB, Wantman E, Schymura MJ, Browne ML, Fisher SC, Forestieri NE, Rao C, Nichols HB, Yazdy MM, Gershman ST, Sacha CR, Williams M, Ethen MK, Canfield MA, Doody KJ, Eisenberg ML, Baker VL, Williams C, Sutcliffe AG, Richard MA, Lupo PJ. The risks of birth defects and childhood cancer with conception by assisted reproductive technology. Hum Reprod 2022; 37:2672-2689. [PMID: 36112004 PMCID: PMC9960485 DOI: 10.1093/humrep/deac196] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/04/2022] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Is there an association between fertility status, method of conception and the risks of birth defects and childhood cancer? SUMMARY ANSWER The risk of childhood cancer had two independent components: (i) method of conception and (ii) presence, type and number of birth defects. WHAT IS KNOWN ALREADY The rarity of the co-occurrence of birth defects, cancer and ART makes studying their association challenging. Prior studies have indicated that infertility and ART are associated with an increased risk of birth defects or cancer but have been limited by small sample size and inadequate statistical power, failure to adjust for or include plurality, differences in definitions and/or methods of ascertainment, lack of information on ART treatment parameters or study periods spanning decades resulting in a substantial historical bias as ART techniques have improved. STUDY DESIGN, SIZE, DURATION This was a population-based cohort study linking ART cycles reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) from 1 January 2004 to 31 December 2017 that resulted in live births in 2004-2018 in Massachusetts and North Carolina and live births in 2004-2017 in Texas and New York. A 10:1 sample of non-ART births were chosen within the same time period as the ART birth. Non-ART siblings were identified through the ART mother's information. Children from non-ART births were classified as being born to women who conceived with ovulation induction or IUI (OI/IUI) when there was an indication of infertility treatment on the birth certificate, and the woman did not link to the SART CORS; all others were classified as being naturally conceived. PARTICIPANTS/MATERIALS, SETTING, METHODS The study population included 165 125 ART children, 31 524 non-ART siblings, 12 451 children born to OI/IUI-treated women and 1 353 440 naturally conceived children. All study children were linked to their respective State birth defect registries to identify major defects diagnosed within the first year of life. We classified children with major defects as either chromosomal (i.e. presence of a chromosomal defect with or without any other major defect) or nonchromosomal (i.e. presence of a major defect but having no chromosomal defect), or all major defects (chromosomal and nonchromosomal), and calculated rates per 1000 children. Logistic regression models were used to generate adjusted odds ratios (AORs) and 95% CIs of the risk of birth defects by conception group (OI/IUI, non-ART sibling and ART by oocyte source and embryo state) with naturally conceived children as the reference, adjusted for paternal and maternal ages; maternal race and ethnicity, education, BMI, parity, diabetes, hypertension; and for plurality, infant sex and State and year of birth. All study children were also linked to their respective State cancer registries. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs of cancer by birth defect status (including presence of a defect, type and number of defects), and conception group. MAIN RESULTS AND THE ROLE OF CHANCE A total of 29 571 singleton children (2.0%) and 3753 twin children (3.5%) had a major birth defect (chromosomal or nonchromosomal). Children conceived with ART from autologous oocytes had increased risks for nonchromosomal defects, including blastogenesis, cardiovascular, gastrointestinal and, for males only, genitourinary defects, with AORs ranging from 1.22 to 1.85; children in the autologous-fresh group also had increased risks for musculoskeletal (AOR 1.28, 95% CI 1.13, 1.45) and orofacial defects (AOR 1.40, 95% CI 1.17, 1.68). Within the donor oocyte group, the children conceived from fresh embryos did not have increased risks in any birth defect category, whereas children conceived from thawed embryos had increased risks for nonchromosomal defects (AOR 1.20, 95% CI 1.03, 1.40) and blastogenesis defects (AOR 1.74, 95% CI 1.14, 2.65). The risk of cancer was increased among ART children in the autologous-fresh group (HR 1.31, 95% CI 1.08, 1.59) and non-ART siblings (1.34, 95% CI 1.02, 1.76). The risk of leukemia was increased among children in the OI/IUI group (HR 2.15, 95% CI 1.04, 4.47) and non-ART siblings (HR 1.63, 95% CI 1.02, 2.61). The risk of central nervous system tumors was increased among ART children in the autologous-fresh group (HR 1.68, 95% CI 1.14, 2.48), donor-fresh group (HR 2.57, 95% CI 1.04, 6.32) and non-ART siblings (HR 1.84, 95% CI 1.12, 3.03). ART children in the autologous-fresh group were also at increased risk for solid tumors (HR 1.39, 95% CI 1.09, 1.77). A total of 127 children had both major birth defects and cancer, of which 53 children (42%) had leukemia. The risk of cancer had two independent components: (i) method of conception (described above) and (ii) presence, type and number of birth defects. The presence of nonchromosomal defects increased the cancer risk, greater for two or more defects versus one defect, for all cancers and each type evaluated. The presence of chromosomal defects was strongly associated with cancer risk (HR 8.70 for all cancers and HR 21.90 for leukemia), further elevated in the presence of both chromosomal and nonchromosomal defects (HR 21.29 for all cancers, HR 64.83 for leukemia and HR 4.71 for embryonal tumors). Among the 83 946 children born from ART in the USA in 2019 compared to their naturally conceived counterparts, these risks translate into an estimated excess of 761 children with major birth defects, 31 children with cancer and 11 children with both major birth defects and cancer. LIMITATIONS, REASONS FOR CAUTION In the SART CORS database, it was not possible to differentiate method of embryo freezing (slow freezing versus vitrification), and data on ICSI were only available in the fresh embryo ART group. In the OI/IUI group, it was not possible to differentiate type of non-ART treatment utilized, and in both the ART and OI/IUI groups, data were unavailable on duration of infertility. Since OI/IUI is underreported on the birth certificate, some OI/IUI children were likely included among the naturally conceived children, which will decrease the difference between all the groups and the naturally conceived children. WIDER IMPLICATIONS OF THE FINDINGS The use of ART is associated with increased risks of major nonchromosomal birth defects. The presence of birth defects is associated with greater risks for cancer, which adds to the baseline risk in the ART group. Although this study does not show causality, these findings indicate that children conceived with ART, non-ART siblings, and all children with birth defects should be monitored more closely for the subsequent development of cancer. STUDY FUNDING/COMPETING INTEREST(S) This project was supported by grant R01 HD084377 from the National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Child Health and Human Development, or the National Institutes of Health, nor any of the State Departments of Health which contributed data. M.L.E. reports consultancy for Ro, Hannah, Dadi, Sandstone and Underdog; presidency of SSMR; and SMRU board member. The remaining authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Barbara Luke
- Correspondence address. Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, 965 Wilson Road, East Fee Hall, Room 628, East Lansing, MI 48824, USA. Tel: +1-517-353-1678; Fax: +1-517-353-1663; E-mail:
| | - Morton B Brown
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Maria J Schymura
- New York State Department of Health, New York State Cancer Registry, Albany, NY, USA,Department of Epidemiology and Biostatistics, School of Public Health, University of Albany, Rensselaer, NY, USA
| | - Marilyn L Browne
- Department of Epidemiology and Biostatistics, School of Public Health, University of Albany, Rensselaer, NY, USA,New York State Department of Health, Birth Defects Registry, Albany, NY, USA
| | - Sarah C Fisher
- New York State Department of Health, Birth Defects Registry, Albany, NY, USA
| | - Nina E Forestieri
- North Carolina Department of Health and Human Services, Birth Defects Monitoring Program, State Center for Health Statistics, Raleigh, NC, USA
| | - Chandrika Rao
- North Carolina Central Cancer Registry, Raleigh, NC, USA
| | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mahsa M Yazdy
- Massachusetts Department of Public Health, Massachusetts Center for Birth Defects Research and Prevention, Boston, MA, USA
| | - Susan T Gershman
- Massachusetts Department of Public Health, Massachusetts Cancer Registry, Office of Data Management and Outcomes Assessment, Boston, MA, USA
| | - Caitlin R Sacha
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Melanie Williams
- Texas Department of State Health Services, Cancer Epidemiology and Surveillance Branch, Texas Health and Human Services, Austin, TX, USA
| | - Mary K Ethen
- Texas Department of State Health Services, Birth Defects Epidemiology and Surveillance Branch, Austin, TX, USA
| | - Mark A Canfield
- Texas Department of State Health Services, Birth Defects Epidemiology and Surveillance Branch, Austin, TX, USA
| | | | - Michael L Eisenberg
- Division of Male Reproductive Medicine and Surgery, Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carrie Williams
- Policy, Practice, and Population Unit, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Alastair G Sutcliffe
- Policy, Practice, and Population Unit, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Melissa A Richard
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA
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9
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Wei SQ, Luu TM, Bilodeau-Bertrand M, Auger N. Assisted reproductive technology and childhood morbidity: a longitudinal cohort study. Fertil Steril 2022:S0015-0282(22)00269-2. [PMID: 35691720 DOI: 10.1016/j.fertnstert.2022.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the association between assisted reproductive technology (ART) and offspring morbidity in the first decade of life. DESIGN Longitudinal cohort study. SETTING Provincial health registry in Quebec, Canada. PATIENT(S) A total of 797,654 singleton children born between 2008 and 2019, followed up to 2020. INTERVENTION(S) Retrospective, noninterventional study of any ART procedure vs. no ART. MAIN OUTCOME MEASURE(S) Childhood morbidity, including hospitalization for infectious, allergic, malignant, and other diseases, assessed using adjusted Cox proportional hazards regression to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the association with ART. We controlled for unmeasured family-level confounders that were shared among siblings through stratified Cox regression. To do so, we restricted the analysis to 10,097 siblings with discordant exposure to ART and compared the risk of outcomes in exposed vs. unexposed siblings. RESULT(S) Compared with no ART, ART was associated with 1.23 times the risk of any hospitalization (95% CI 1.19-1.27), 1.25 times the risk of infectious disease hospitalization (95% CI 1.21-1.29), and 1.25 times the risk of allergy hospitalization (95% CI 1.14-1.38). When we used a sibling design to control for shared genetic and environmental confounders, ART was not associated with a greater risk of childhood hospitalization (HR 0.92, 95% CI 0.78-1.08). CONCLUSION(S) ART is associated with an elevated risk of hospitalization up to 11 years of age, but discordant sibling analysis suggests that the association may be due to genetic, environmental, or other shared familial confounders.
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10
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Arshad A, Sutcliffe AG. Cancer risk in children born after assisted reproductive technology. Gynäkologische Endokrinologie 2020; 18:226-30. [DOI: 10.1007/s10304-020-00334-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Bovbjerg ML. Current Resources for Evidence-Based Practice, September 2020. J Obstet Gynecol Neonatal Nurs 2020; 49:487-499. [PMID: 32805207 PMCID: PMC7428455 DOI: 10.1016/j.jogn.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of “spin” in scientific reporting and its effect on summaries and syntheses of the literature and commentaries on reviews about early versus late amniotomy as part of labor induction protocols and the economic burden associated with maternal morbidity.
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12
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Zhang Y, Gao R, Chen H, Xu W, Yang Y, Zeng X, Sun X, Zhang S, Hu X, Qin L. The association between fertility treatments and the incidence of paediatric cancer: A systematic review and meta-analysis. Eur J Cancer 2020; 138:133-148. [PMID: 32889368 DOI: 10.1016/j.ejca.2020.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/27/2020] [Accepted: 08/05/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND It is important to explore the association between different fertility treatments and the incidence of paediatric cancer, as this will provide crucial guidance for clinical decision-making. Previous studies have explored the relationship between fertility treatments and different types of cancer in offspring, but the results are controversial. METHOD Two authors searched PubMed, Embase, Web of Science and Cochrane databases independently to acquire qualified studies. Then, the same authors extracted data from these studies and analysed these data using RevMan 5.3. MAIN RESULTS Eleven case-control studies and 16 cohort studies were included in this review and meta-analysis. The relative risk of association between in vitro fertilisation (IVF) and paediatric cancer incidence was 1.01 (95% confidence interval [CI]: 0.80-1.28) in cohort studies and 1.09 (95% CI: 0.74-1.58) in case-control studies. The relative risk of association between intracytoplasmic sperm injection (ICSI) and paediatric cancer incidence was 0.97 (95% CI: 0.80-1.17) in cohort studies. The relative risk of association between fertility drugs and paediatric cancer incidence was 1.07 (95% CI: 0.68-1.69) in cohort studies and 1.12 (95% CI: 0.90-1.41) in case-control studies. The relative risk of association between frozen embryo transfer and paediatric cancer incidence was 1.37 (95% CI: 1.04-1.81) in natural pregnancy controls and 1.28 (95% CI: 0.96-1.69) in fresh embryo transfer controls. CONCLUSION There is no evidence that IVF, ICSI and fertility drugs are associated with an increase in paediatric cancer incidence in offspring; however, frozen embryo transfer is associated with an increase in paediatric cancer incidence in the offspring, but this finding needs further research and attention.
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Affiliation(s)
- Yaoyao Zhang
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Rui Gao
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China; West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Hanxiao Chen
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China; West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Wenming Xu
- SCU-CUHK Joint Laboratory for Reproductive Medicine, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yihong Yang
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Xun Zeng
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaochi Sun
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Sirui Zhang
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Xiao Hu
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Lang Qin
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China.
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13
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Reigstad MM, Storeng R. Inaccurate reporting in an article about pediatric cancers after in vitro fertilization in Israel. Cancer Epidemiol 2020; 67:101735. [PMID: 32534824 DOI: 10.1016/j.canep.2020.101735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/20/2019] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Marte Myhre Reigstad
- Oslo University Hospital, Norwegian National Advisory Unit on Women's Health, Postboks 4950 Nydalen, 0424 Oslo, Norway.
| | - Ritsa Storeng
- Oslo University Hospital, Norwegian National Advisory Unit on Women's Health, Postboks 4950 Nydalen, 0424 Oslo, Norway
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14
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von Wolff M, Haaf T. In Reply. Dtsch Arztebl Int 2020; 117:422. [PMID: 32865496 PMCID: PMC7477697 DOI: 10.3238/arztebl.2020.0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Michael von Wolff
- *University Women’s hospital Division of Gynecologic Endocrinology and Reproductive Medicine Inselspital Bern, Bern, Switzerland
| | - Thomas Haaf
- **Institute of Human Genetics, Julius Maximilians University, Würzburg, Germany
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15
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Schraw JM, Desrosiers TA, Nembhard WN, Langlois PH, Meyer RE, Canfield MA, Rasmussen SA, Chambers TM, Spector LG, Plon SE, Lupo PJ. Cancer diagnostic profile in children with structural birth defects: An assessment in 15,000 childhood cancer cases. Cancer 2020; 126:3483-3492. [PMID: 32469081 DOI: 10.1002/cncr.32982] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Birth defects are established risk factors for childhood cancer. Nonetheless, cancer epidemiology in children with birth defects is not well characterized. METHODS Using data from population-based registries in 4 US states, this study compared children with cancer but no birth defects (n = 13,111) with children with cancer and 1 or more nonsyndromic birth defects (n = 1616). The objective was to evaluate cancer diagnostic characteristics, including tumor type, age at diagnosis, and stage at diagnosis. RESULTS Compared with the general population of children with cancer, children with birth defects were diagnosed with more embryonal tumors (26.6% vs 18.7%; q < 0.001), including neuroblastoma (12.5% vs 8.2%; q < 0.001) and hepatoblastoma (5.0% vs 1.3%; q < 0.001), but fewer hematologic malignancies, including acute lymphoblastic leukemia (12.4% vs 24.4%; q < 0.001). In age-stratified analyses, differences in tumor type were evident among children younger than 1 year and children 1 to 4 years old, but they were attenuated among children 5 years of age or older. The age at diagnosis was younger in children with birth defects for most cancers, including leukemia, lymphoma, astrocytoma, medulloblastoma, ependymoma, embryonal tumors, and germ cell tumors (all q < 0.05). CONCLUSIONS The results indicate possible etiologic heterogeneity in children with birth defects, have implications for future surveillance efforts, and raise the possibility of differential cancer ascertainment in children with birth defects. LAY SUMMARY Scientific studies suggest that children with birth defects are at increased risk for cancer. However, these studies have not been able to determine whether important tumor characteristics, such as the type of tumor diagnosed, the age at which the tumor is diagnosed, and the degree to which the tumor has spread at the time of diagnosis, are different for children with birth defects and children without birth defects. This study attempts to answer these important questions. By doing so, it may help scientists and physicians to understand the causes of cancer in children with birth defects and diagnose cancer at earlier stages when it is more treatable.
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Affiliation(s)
- Jeremy M Schraw
- Department of Medicine, Baylor College of Medicine, Houston, Texas.,Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, Texas
| | - Tania A Desrosiers
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Wendy N Nembhard
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Peter H Langlois
- Birth Defects Epidemiology and Surveillance Branch, Department of State Health Services, Austin, Texas
| | - Robert E Meyer
- Department of Maternal and Child Health, University of North Carolina, Chapel Hill, North Carolina.,State Center for Health Statistics, North Carolina Division of Public Health, Raleigh, North Carolina
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Department of State Health Services, Austin, Texas
| | - Sonja A Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida.,Department of Epidemiology, University of Florida College of Medicine and College of Public Health and Health Professions, Gainesville, Florida
| | - Tiffany M Chambers
- Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Logan G Spector
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Sharon E Plon
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Philip J Lupo
- Department of Medicine, Baylor College of Medicine, Houston, Texas.,Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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