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Study finds infertility is a modest risk factor for the development of ADHD in childhood

0 2 years ago

In a recent study published in Human Reproduction, researchers evaluated the risk of attention-deficit hyperactivity disorder (ADHD) in offspring of infertile mothers or those receiving infertility treatment compared to offspring of mothers with unaided conception.


Studies investigating the long-term neurodevelopmental outcomes in offspring of mothers with infertility and/or receiving infertility treatment are limited. Previous studies have shown increased risks of behavioral, cognitive, and emotional impairments post-exposure to infertility treatment. However, studies evaluating the association between infertility treatment and ADHD have shown inconsistent results, and the causes of such associations are unclear.

About the study

In the present study, researchers investigated whether the risk of ADHD was higher among offspring born to mothers with infertility and/or receiving infertility treatment than mothers who conceived without such assistance.

The study was conducted between 2006 and 2014 in the Ontario province of Canada and comprised single and multiple hospital live births at 24 weeks gestation by mothers aged between 18 and 55 years at the time of delivery with a valid Ontario health insurance program (OHIP) number.

Data on infertility treatment, hospital births, maternal health, pregnancy measures, and outcomes in the offspring were obtained from the inpatient and outpatient records of the institute for clinical evaluative sciences (ICES) datasets. Data were obtained on pregnancy characteristics such as the type of conception from the better outcomes registry & network (BORN) database and its associated Niday legacy datasets.

The team excluded the offspring of surrogate mothers from the analysis due to the gestational and biological complexities of surrogacy. Pregnancies resulting in abortions or death of the offspring before four years of age or those with inadequate data records were also excluded.

The prime exposure was the conception mode as follows: (i) unaided conception group (for reference), (ii) infertility with no corresponding treatment, diagnosed within two years before conception (international classification of diseases, ninth revision (ICD-9) code 628); (iii) ovulation induction (OI)/ intrauterine insemination (IUI) and (iv) in vitro fertilization (IVF)/intracytoplasmic sperm injections (ICSI).

The prime outcome was ADHD diagnosis in the offspring after the age of four years, described as two outpatient diagnoses (ICD-9 codes 312-14) by either a psychiatrist or pediatrician and/or one diagnosis during hospitalization (ICD-10 F90,91). The outcome was assessed till June 2020.

The team calculated hazard ratios (HRs) after data adjustments for the mother’s age, rural residency, income, the status of immigration, parity, smoking habits, obesity, use of alcohol and/or drugs, and mother’s medical history, including mental illnesses (such as ADHD), chronic hypertension, non-gestational diabetes, and sex of the child. Additionally, stratified analyses were performed by delivery mode (cesarean or vaginal delivery), sex of the infant, multiplicity (single or multiple), and the infant birth timing (preterm or term).

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