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Fertility Therapies, Infertility and Autism Spectrum Disorders in the Nurses' Health Study II

Authors

  • Kristen Lyall,

    Corresponding author
    1. Department of Nutrition
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  • David L. Pauls,

    1. Department of Epidemiology
    2. Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital
    3. Department of Psychiatry, Harvard Medical School
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  • Donna Spiegelman,

    1. Department of Epidemiology
    2. Department of Biostatistics, Harvard School of Public Health
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  • Susan L. Santangelo,

    1. Department of Epidemiology
    2. Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital
    3. Department of Psychiatry, Harvard Medical School
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  • Alberto Ascherio

    1. Department of Nutrition
    2. Department of Epidemiology
    3. Department of Medicine, Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Kristen Lyall, 1616 Da Vinci Court, Davis, CA 95618, USA. E-mail: klyall@hsph.harvard.edu

Abstract

Background:  An increasing number of women are utilizing fertility treatments, but little is known about their relation to autism spectrum disorders (ASD).

Methods:  To determine the association between maternal fertility therapy use and risk of having a child with ASD, we conducted a nested case-control study within the Nurses' Health Study II (n = 116,430). Maternally reported diagnoses of ASD were confirmed through a supplementary questionnaire and, in a subgroup, the Autism Diagnostic Interview-Revised. Controls were randomly selected by frequency matching to case children's year of birth. Associations were examined by self-reported infertility and type of therapy using conditional logistic regression.

Results:  In all, 9% of the 507 cases and 7% of 2,529 controls indicated fertility therapy use for the index pregnancy. No significant associations with self-reported fertility therapies or history of infertility were seen in primary analyses. In subgroup analyses of women with maternal age ≥35 years (n = 1,020), artificial insemination was significantly associated with ASD; ovulation inducing drug (OID) use was significantly associated in crude but not adjusted analyses (odds ratio 1.81, 95% CI 0.96–3.42). Results were similar by diagnostic subgroup, though within the advanced maternal age group, OID and artificial insemination were significantly associated with Asperger syndrome and pervasive developmental disorder not-otherwise specified, but not autistic disorder.

Conculsion:  Assisted reproductive therapy and history of infertility did not increase risk of having a child with ASD in this study. However, the associations observed with OID and artificial insemination among older mothers, for whom these exposures are more common, warrant further investigation.

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