1
|
O-087 Asthma and allergies in a cohort of adolescents conceived after assisted reproductive technologies (ART). Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Are adolescents conceived after assisted reproductive technologies (ART) at an increased risk of asthma and allergies, compared to their counterparts conceived without ART?
Summary answer
No difference in asthma prevalence, better lung-function, and an increase in allergic rhinoconjunctivitis, food allergies and positive skin-prick tests are reported in the ART cohort.
What is known already
Over 8 million children have been born after conception with ART worldwide. Emerging evidence shows an increased risk of atopic disorders, such as asthma and allergies, in such children, potentially due to epigenetic alterations or underlying parental subfertility and perinatal risk factors. Studies to date are highly heterogeneous, including non-standardized diagnostic tools, non-representative reference populations, and lacking appropriate covariate adjustment. With the increase in atopic disorders worldwide, and the burden they bring to the life of individuals and to society, in combination with the increase in ART, it is important to further investigate the risk of atopy in such offspring.
Study design, size, duration
The Growing Up Healthy Study (GUHS) is a prospective study that recruited 303 offspring conceived after ART (aged 13-21), born 1991-2001 in Western Australia. Their health parameters, including asthma and allergy assessments, were compared with those of counterparts conceived without ART, from the Raine Study Generation 2 (Gen2). The 2,868 Gen2 participants are representative of the local population. At age 14 (2013-2017), 152 GUHS participants replicated atopy assessments previously completed by similarly aged Gen2 participants.
Participants/materials, setting, methods
Asthma and allergy assessments consisted of a parent-completed modified version of the ‘International Studies of Asthma and Allergies in Childhood’ (ISAAC) questionnaire, spirometry, methacholine challenge- and skin-prick testing (SPT). Chi2, Fisher’s Exact and Mann-Whitney U tests, performed in SPSS V25, examined cohort differences, and generalized estimating equations adjusted for (a subset of) the following covariates: sex, age, height, singleton pregnancy, gestational age, birthweight, mode of delivery, primary caregiver smoking, and being an only child.
Main results and the role of chance
Current asthma and asthma severity, based on the ISAAC questionnaire, appeared similar between the cohorts. Lung function (mean Forced Expiratory Volume [FEV1], Forced Vital Capacity [FVC] and FEV1/FVC ratio) was better in the ART cohort (3.10 vs. 2.96 L, p = 0.011; 3.72 vs. 3.29 L, p < 0.001; 85.5 vs. 91.8%, p < 0.001, respectively). No difference in mean Forced Expiratory Flow was reported. Bronchial hyperresponsiveness was significantly less prevalent in the ART cohort (8.8% vs.18.6% p = 0.006).
Current allergic rhinoconjunctivitis (ARC) rates were significantly higher in the ART cohort (32.4% vs. 25.2%, aOR 1.52 [1.03-2.26], p = 0.036), while prevalence of current atopic dermatitis did not differ. Food allergies were twice as prevalent in the ART cohort (20.7 vs. 10.9%, aOR 1.89 [1.17-3.06], p = 0.010). Significantly more GUHS participants had a positive SPT (68.0% vs. 45.4%, aOR 3.034 [1.989-4.628], p < 0.001). The percentage of polysensitisation (> 1 allergen) did not differ between the cohorts. Sub-analyses comparing offspring conceived after in vitro fertilisation (IVF)[n = 100] and intracytoplasmic sperm injection (ICSI)[n = 40], and fresh and frozen embryo transfers (ETs n = 82, FETs n = 58) within the ART cohort, showed no significant differences, although all allergy outcomes appeared more prevalent in the ET group.
Limitations, reasons for caution
Despite substantial study size, numbers did not allow for adjustment for all covariates. Sub-analyses (IVF vs. ICSI and ET vs. FET), were conducted with limited power and require replication in larger cohorts. Both cohorts were largely of Caucasian decent (>88.0%), which reduces applicability of findings to other ethnicities.
Wider implications of the findings
Reassuringly, adolescents conceived after ART had better lung-function than their counterparts and no differences in asthma prevalence. The reported increase in allergies in ART conceived adolescents is of importance to families and healthcare providers, and opens possibilities for targeted screening and treatment. Further studies are required to confirm our findings.
Trial registration number
Not applicable
Collapse
|
2
|
O-072 Markers of cardiometabolic health of adolescents conceived through assisted reproductive technologies (ART) appear reassuring. Hum Reprod 2021. [DOI: 10.1093/humrep/deab125.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Is the cardiometabolic health of adolescents conceived through ART worse than that of their spontaneously-conceived counterparts?
Summary answer
The majority of cardiometabolic and vascular health parameters of ART-conceived adolescents are more favourable than those of their spontaneously-conceived counterparts of similar age.
What is known already
It has been proposed that ART induces epigenetic alterations during embryonic development which could lead to cardiometabolic disease later in life. However, individuals requiring ART may themselves be metabolically less healthy than the general population, which could lead to a genetically increased risk of cardiometabolic disorders in the offspring, rather than the ART procedure. The literature pertaining to cardiometabolic health of ART-conceived offspring is contradictory, but generally suggests unfavourable cardiometabolic health parameters. With over 8 million children and adults born through ART worldwide, it is imperative to investigate whether early signs of adverse cardiometabolic differences persist into adolescence and beyond.
Study design, size, duration
The Growing Up Healthy Study (GUHS) is a prospective study that recruited 303 ART-conceived adolescents, born 1991-2001 in Western Australia. Their health parameters, including cardiometabolic factors, were assessed and compared with spontaneously conceived counterparts of similar socioeconomic background and age from the Raine Study Generation 2 (Gen2). The 2868 Gen2 participants were born 1989-1992 and are representative of the Western Australian adolescent population. At age 16-17 (2013-2017), GUHS participants replicated assessments previously completed by Gen2.
Participants/materials, setting, methods
Cardiometabolic parameters were compared between 165 GUHS (male = 50.9%) and 1690 Gen2 (male = 49.8%) adolescents. Assessments consisted of a detailed questionnaire; health and demographic parameters, anthropometric assessments; height, weight, body-mass index (BMI), waist circumference and skinfold thickness, fasting serum biochemistry, arterial stiffness and blood pressure assessment using applanation tonometry, assessment of non-alcoholic fatty liver (NAFLD) and thickness of abdominal fat compartments using ultrasonography. Chi2, Fisher’s Exact and Mann-Whitney U tests, performed in SPSS V25, examined cohort differences.
Main results and the role of chance
GUHS adolescents appeared to be healthier from a cardiometabolic perspective than their Gen2 counterparts. They were leaner, with lower BMI (median: 21.23 vs. 22.06, P = 0.004), lower waist circumference (median: 74.10 vs. 76.75 cm, P = 0.031), and thinner skinfolds (triceps median: 12.1 vs. 14.0 mm, P = 0.019, subscapular median: 10.6 vs. 11.9 mm, P < .001, mid-abdominal median: 16.0 vs. 19.9 mm, P < 0.001, supraspinal median: 10.7 vs. 13.5 mm, P < 0.001). No significant differences were detected in the following serum fasting parameters: glucose, insulin, HOMA-IR, LDL cholesterol, total cholesterol, cholesterol/HDL-ratio, triglycerides, CRP and ALT. HDL cholesterol levels were more favourable in GUHS (P < 0.001). NAFLD was present in 10.9% of GUHS vs. 15.2% of Gen2 adolescents (P = 0.174), with no difference in steatosis severity score (P = 0.309). ART offspring had less subcutaneous adipose tissue (median: 8.0 vs. 14.0 mm, P < .001), more visceral adipose tissue (median: 40.0 vs. 32.0 mm, P < 0.001), with no difference in pre-peritoneal adipose tissue (P = 0.087). Measures of arterial stiffness were lower in GUHS. Pulse wave velocity: median 6.1 vs. 6.4 m/s, P < 0.001 and heart rate corrected augmentation index: median -10.25 vs. -8.00, P = 0.006. No significant differences in blood pressure or heart rate were detected. Stratification by sex did not greatly alter the results.
Limitations, reasons for caution
Despite the substantial study size and the unique study design, we were unable to differentiate between different types of ART (e.g. IVF vs. ICSI), draw definite conclusions or relate outcomes to cause of infertility. Given the observational character of this study, causation cannot be proven.
Wider implications of the findings
In this study we did not detect any adverse effect of ART on cardiometabolic health at adolescence, in contrast to some studies. Given the lack of consensus, future well-designed and appropriately-powered studies are necessary to investigate cardiometabolic health in ART adults.
Trial registration number
not applicable
Collapse
|