79 - Neurodevelopmental Outcomes of VLBW Preterm Infants Conceived by Assisted Reproductive Technology

Publication Number: 3075.79

Shen Ko, National Taiwan University Children's Hospital, Taipei city, Taipei, Taiwan (Republic of China); Po-Nien Tsao, National Taiwan Univsersity Hospital, TAIPEI, Taipei, Taiwan (Republic of China); Hsin-Chung Huang, National Taiwan University Children's Hospital, Taipei, Taipei, Taiwan (Republic of China); Ting-An Yen, National Taiwan University Children’s hospital, Taipei, Taipei, Taiwan (Republic of China); Chien-Yi Chen, National Taiwan University Children’s hospital, Taipei, Taipei, Taiwan (Republic of China); Hung-Chieh Chou, National Universisty Hospital Children's Hospital, Taipei, Taipei, Taiwan (Republic of China)

Background: The use of assisted reproductive technology (ART) has risen globally, leading to more ART-conceived infants. Although ART effectively treats infertility, its link to adverse neonatal and neurodevelopmental outcomes remains controversial. Previous studies have shown increased risks of preterm birth, low birth weight, and neurodevelopmental disorders such as cerebral palsy and autism. However, these associations often diminish after adjusting for factors like gestational age and multiple pregnancies, and some reports even suggest better outcomes among ART offspring. Very low birth weight (VLBW) infants are highly susceptible to neurodevelopmental impairment (NDI). With the growing prevalence of ART and preterm births, it is essential to clarify the neurodevelopmental outcomes in this high-risk population.

Objective: We aimed to compare the perinatal and neurodevelopmental outcomes between very low birth weight premature infants conceived by ART and infants conceived spontaneously.

Design/Methods: This retrospective multicenter cohort study used data from the Taiwan Premature Infant Follow-up Network database on infants born between 1998 and 2017. The primary outcomes were the survival-to-discharge rate and neurodevelopmental impairment (NDI) (moderate-to-severe neurological disability). We also considered major morbidities related to extreme premature infants as secondary outcomes. Multivariable logistic regression assessed the association between the conception method and outcomes, adjusting for gestational age, sex, and other factors.

Results: The study enrolled 19,796 premature very low birth weight infants, of whom 3,735 (18.87%) were conceived by ART. In the ART group, multiple gestation was significantly more common and parents were significantly older and more educated (all p< 0.001), compared with the spontaneous group. The NDI incidence rates at the corrected age of 2 years were lower in the ART group versus the spontaneous group (p=0.01); this difference remained significant after multivariate adjustment. Compared with infants conceived spontaneously, those conceived by ART had lower incidence rates of bronchopulmonary dysplasia (p < 0.001), sepsis (p < 0.001), necrotizing enterocolitis (p=0.001), but higher incidence rates of severe retinopathy of prematurity (p=0.003).

Conclusion(s): In our cohort, premature infants conceived by ART had lower NDI incidence rates at the corrected age of 2 years than naturally conceived infants did.

Table 1: Demographic of the study population
* p < 0.05. Categorical variables were analyzed using the chi-square test or Fisher's exact test, while continuous variables were evaluated using the independent t-test.
† ART (assisted reproductive technology), SGA (small for gestational age)

Table 2: Primary outcome and secondary outcome
* p < 0.05. Categorical variables were analyzed using the chi-square test or Fisher's exact test, while continuous variables were evaluated using the independent t-test
† ART (assisted reproductive technology), NDI (neurodevelopmental impairment), ROP (retinopathy of prematurity), PDA (patent ductus arteriosus), IVH (intraventricular hemorrhage)
a. Diagnosis at corrected age 24-month-old
b. Defined as requiring oxygen supplementation or any type of respiratory support by the 36 weeks postmenstrual age for infants born < 32 weeks gestational age or by 56 day old for infants born ≥ 32 weeks gestational age

Table 3: Multivariate logistic regression model to determine independent factors associated with neurodevelopmental impairment
* p < 0.05. Categorical variables were analyzed using the chi-square test or Fisher's exact test, while continuous variables were evaluated using the independent t-test.
† ART (assisted reproductive technology), GDM (gestational diabetes mellitus), RDS (retinopathy of prematurity), PDA (patent ductus arteriosus), NEC (necrotizing enterocolitis), ROP (retinopathy of prematurity), BPD (bronchopulmonary dysplasia), IVH (intraventricular hemorrhage), PVL (periventricular leukomalacia)
a. Cases of mortality were excluded.
b. Defined as requiring oxygen supplementation or any type of respiratory support by the 36 weeks postmenstrual age for infants born < 32 weeks gestational age or by 56 days old for infants born ≥ 32 weeks gestational age