TOPLINE:

Children conceived through medically assisted reproduction (MAR) have higher out-of-hospital healthcare utilization than naturally conceived children, with significantly increased costs at ages 2-3 and 4-5 years. MAR-conceived children show two to three times higher odds of being prescribed attention-deficit/hyperactivity disorder (ADHD) medications and up to five times higher odds of receiving mental health medications in early childhood.

METHODOLOGY:

• Researchers analyzed data from the Growing up in Australia: Longitudinal Study of Australian Children (LSAC), a population-based longitudinal cohort study in Australia, linked with Medicare administrative records to examine healthcare utilization from birth to age 16 years.
• A total of 4789 singleton children were included, with 246 conceived through MAR (identified via maternal self-report of fertility drugs, in vitro fertilization, or other medical treatments) and 4543 naturally conceived children, who were followed from 2004 to 2018.
• Out-of-hospital healthcare service utilization and costs were compared between groups using generalized linear models with gamma distribution and log link, adjusting for child sex, birth weight, gestational age, cesarean delivery, parental age, pregnancy conditions, equivalized parental income, maternal education, language, Indigenous status, remoteness, and socioeconomic status.
• Prescription medication use was categorized into adrenaline autoinjectors, asthma medications, eczema medications, ADHD medications, mental health medications, nutrition products, anti-infectives, and other medications, with logistic regression models applied to estimate associations.
• Primary outcomes included total out-of-hospital health costs by 2-year age bands and use of prescription medications across different age groups, with ADHD medications analyzed from age 6 years and mental health medications from age 4 years.

TAKEAWAY:

• MAR-conceived children had significantly higher healthcare costs than naturally conceived children at ages 2-3 years (mean difference, $87.53; 95% CI, $8.87-$166.19) and 4-5 years (mean difference, $117.53; 95% CI, $30.95-$204.11) after controlling for birth, pregnancy conditions, and socioeconomic characteristics.
• For ages 6-15 years, MAR-conceived children had 2.41-3.20 times the odds of being prescribed ADHD medications compared with naturally conceived children (95% CI, 1.15-5.08 to 1.54-6.64; P < .05) after adjusting for covariates.
• MAR-conceived children demonstrated 5.24 times the odds of being prescribed mental health medications at ages 4-5 years (95% CI, 2.02-13.58) and 2.96 times the odds at ages 6-7 years (95% CI, 1.23-7.13) compared with naturally conceived children after covariate adjustment.
• No significant differences were observed between MAR-conceived and naturally conceived children in the use of adrenaline autoinjectors, asthma medications, eczema medications, anti-infectives, or other medications across age groups.

IN PRACTICE:

“This study highlights a higher need for long-term healthcare services and associated resources for medically assisted reproduction-conceived children, which can’t be explained by socioeconomic-related parental health-seeking behaviors and perinatal factors like multiple birth and birth weight. This helps anticipate the downstream financial impact for the health system associated with the increasing use of medically assisted reproduction and emphasizes an opportunity for early screening and detection of relevant health conditions among children conceived with medically assisted reproduction,” wrote the authors of the study.

SOURCE:

The study was led by Xinyang Hua, PhD, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia. It was published online in the American Journal of Obstetrics and Gynecology.

LIMITATIONS:

Children conceived through MAR were identified by parental self-report rather than registry data, which may be less accurate, though previous studies have shown maternally reported reproduction information to be valid. The study could not distinguish between different types of fertility treatments (assisted reproductive technology vs less invasive treatments) or separate whether health issues were related to MAR itself or secondary to parental subfertility. Despite adjusting for many potential confounders, other extraneous variables such as early-life lifestyle factors and parental health-seeking behaviors not fully captured by socioeconomic characteristics may influence the findings. The study could not control for parental factors beyond age and maternal pregnancy conditions, including underlying infertility and parental health conditions such as ADHD and mental health disorders that may influence children. The findings reflect MAR practices from 2003 to 2004, and advances in medication regimens and embryo transfer strategies in recent years may limit generalizability to contemporary MAR conceptions.

DISCLOSURES:

No specific grant from any funding agency supported this research. Hua disclosed receiving support from an Australian National Health and Medical Research Council grant (2009253). All authors confirmed that there are no conflicts of interest, relationships, or activities to disclose.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.