Published online August 1, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. 475-482 (doi:10.1542/peds.2005-2585)
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ARTICLE

Cerebral Palsy Among Children Born After in Vitro Fertilization: The Role of Preterm Delivery—A Population-Based, Cohort Study

Dorte Hvidtjørn, MPHa, Jakob Grove, PhDa, Diana E. Schendel, PhDb, Michael Væth, PhDc, Erik Ernst, PhDd, Lene F. Nielsen, MPHa and Poul Thorsen, PhDa

a North Atlantic Neuro-Epidemiology Alliances, Department of Epidemiology
c Department of Biostatistics, Institute of Public Health, University of Aarhus, Aarhus, Denmark
b Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
d Fertility Section, Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark

OBJECTIVE. Our aim was to assess the incidence of cerebral palsy among children conceived with in vitro fertilization and children conceived without in vitro fertilization.

METHODS. A population-based, cohort study, including all live-born singletons and twins born in Denmark between January 1, 1995, and December 31, 2000, was performed. Children conceived with in vitro fertilization (9255 children) were identified through the In Vitro Fertilization Register; children conceived without in vitro fertilization (394713) were identified through the Danish Medical Birth Register. Cerebral palsy diagnoses were obtained from the National Register of Hospital Discharges. The main outcome measure was the incidence of cerebral palsy in the in vitro fertilization and non-in vitro fertilization groups.

RESULTS. Children born after in vitro fertilization had an increased risk of cerebral palsy; these results were largely unchanged after adjustment for maternal age, gender, parity, small-for-gestational age status, and educational level. The independent effect of in vitro fertilization vanished after additional adjustment for multiplicity or preterm delivery. When both multiplicity and preterm delivery were included in the multivariate models, preterm delivery remained associated strongly with the risk of cerebral palsy.

CONCLUSIONS. The large proportions of preterm deliveries with in vitro fertilization, primarily for twins but also for singletons, pose an increased risk of cerebral palsy.

Key Words: in vitro fertilization • cerebral palsy • preterm

Abbreviations: IVF—in vitro fertilization • ICSI—intracytoplasmic sperm injection • CP—cerebral palsy • NRHD—National Register of Hospital Discharges • HRR—hazard rate ratio • CI—confidence interval • SGA—small for gestational age

Accepted Mar 6, 2006.




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