| 11. |
- Källén, Bengt, et al.
(författare)
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In vitro fertilisation in Sweden: obstetric characteristics, maternal morbidity and mortality
- 2005
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Ingår i: Bjog. - : Wiley. ; 112:11, s. 1529-1535
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate obstetric characteristics, maternal morbidity and mortality among Swedish women giving birth after in vitro fertilisation (IVF) treatment. DESIGN: Register study. SETTING: Nationwide study in Sweden. SAMPLE: All women known to have had IVF in Sweden 1982-2001. METHODS: Using Swedish health registers, women who had given birth after IVF were identified from all Swedish IVF clinics and compared with all women who gave birth. Analysis was performed with the Mantel-Haenszel technique. MAIN OUTCOME MEASURES: Diagnoses during pregnancy, at delivery and at re-admission within 60 days after delivery and risk of cancer. RESULTS: IVF women had an increased risk of bleeding in early pregnancy [odds ratio (OR) = 4.59, 95% confidence interval (95% CI) 4.08-5.15] and of ovarian torsion during pregnancy (OR = 10.6, 5.69-10.7). They were also more likely to encounter pre-eclampsia (OR = 1.63, 1.53-1.74), placental abruption (2.17, 1.74-2.72), placenta praevia (3.65, 3.15-4.23), bleeding in association with vaginal delivery (1.40, 1.38-1.50) and premature rupture of membranes (PROM) (2.54, 2.34-2.76). Interventions including caesarean sections (1.38, 1.32-1.43) and induction of labour (1.37, 1.29-1.46) in singleton pregnancies was more frequent. The type of IVF method had little effect on these results, but there was a tendency for women who had received intra-cytoplasmatic sperm injection (ICSI) to have slightly fewer complications than women having standard IVF. There was a significant decrease in cancer risk after IVF (0.79, 0.69-0.91) but a suggested increase in the risk of ovarian cancer both before (2.70, 1.49-4.91) and after (2.08, 1.15-3.76) IVF. No change in mortality was observed. CONCLUSIONS: Women treated with IVF had an increased obstetric morbidity. This seems to contribute little to the well-known increased risk of preterm delivery.
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| 12. |
- Källén, Bengt, et al.
(författare)
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Is there an increased risk for drug treated attention deficit/hyperactivity disorder in children born after in vitro fertilization?
- 2011
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Ingår i: EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY. - : Elsevier Science B.V., Amsterdam. - 1090-3798. ; 15:3, s. 247-253
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is mounting evidence that children born after in vitro fertilization (IVF) run an increased risk of neurological complications and notably cerebral palsy. Whether developmental disturbances occur more often than expected is debated. Aim: To investigate the risk for ADHD in children conceived after IVF. Methods: Children conceived after IVF and born between 1982 and 2005 were identified from all IVF clinics in Sweden. Children who developed attention deficit/hyperactivity disorder (ADHD) were identified with the use of a register over all prescribed drugs in Sweden, using prescriptions for methylphenidate or atomixetine as indicators of ADHD. Maternal and neonatal characteristics were obtained by linkage with the Medical Birth Register and relevant confounders were adjusted for using Mantel-Haenszel procedures. We studied 28158 children born after IVF and compared them with 2417886 children in the population. Results: After adjustment for year of birth, maternal age, parity, smoking, BMI, and maternal education and after exclusion of women who did not cohabit, a weak but statistically significant association was found with an odds ratio = 1.18, 95% confidence interval 1.03-1.36. The effect was stronger in girls (OR = 1.40) than boys (OR = 1.11) but this difference could be random. After adjustment for length of involuntary childlessness, the OR decreased slightly and lost statistical significance. Conclusions: The study suggests a weak association between IVF and drug treated ADHD.
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| 13. |
- Källén, Bengt, et al.
(författare)
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Malignancies among women who gave birth after in vitro fertilization
- 2011
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Ingår i: HUMAN REPRODUCTION. - : Oxford University Press. - 0268-1161 .- 1460-2350. ; 26:1, s. 253-258
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Relatively few studies published to date have investigated IVF and cancer risk. In this study we compared the occurrence of cancer in women who gave birth after IVF with all other women who gave birth in the study period. METHODS: All women who were treated with IVF and gave birth during the years 1982-2006 in Sweden were identified from all IVF clinics, and the occurrence of cancer in these women was identified by linkage with the nationwide Swedish cancer register. Comparison was made with Mantel-Haenszel odds ratios (ORs), adjusting for year of delivery and maternal age, parity and smoking. Cancer before IVF was only studied in first parity women. Specific cancer forms were also studied. RESULTS: Among 24 058 women who had been treated with IVF, 1279 appeared in the cancer register. The total number of women studied in the population was 1 394 061, and 95 775 of these were registered in the cancer register. The risk for cancer before IVF was increased [OR 1.37, 95% confidence interval (CI) 1.27-1.48] and was especially high for ovarian cancer (3.93). The risk for cancer after IVF was significantly lower (OR 0.74, 95% CI 0.67-0.82), mainly due to a lower than expected risk for breast and cervical cancer. The risk for ovarian cancer was increased but lower than the risk before IVF (2.13). CONCLUSIONS: Cancer or cancer treatment may increase the risk for infertility leading to IVF. After IVF, in most cases with treatment with fertility hormones, a significantly low cancer risk was found. Ovarian cancer showed an increased risk, although lower than before IVF. One possible reason is ovarian pathology causing both infertility and an increased cancer risk.
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| 14. |
- Källén, Bengt, et al.
(författare)
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Selected neonatal outcomes in dizygotic twins after IVF versus non-IVF pregnancies
- 2010
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Ingår i: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY. - : Blackwell Publishing Ltd.. - 1470-0328 .- 1471-0528. ; 117:6, s. 676-682
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Tidskriftsartikel (refereegranskat)abstract
- Objective To compare neonatal outcome among twins conceived after in vitro fertilisation (IVF) with that of spontaneously conceived twins. Design Comparison of different-sex (dizygotic) twins born after IVF with non-IVF dizygotic twins. Setting National health registers in Sweden. Population All births in Sweden during the period 1982-2007. Methods We studied gestational duration, lowest birthweight and birthweight difference in the twin pair, presence of one or two twins with a respiratory complication, and with jaundice in one or both twins. Risk estimates were calculated as odds ratios with adjustments for year of birth, maternal age, parity and smoking in pregnancy. Main outcome measures Gestational duration, birth weight, respiratory complications, jaundice. Results We studied 1545 pairs of dizygotic twins born after IVF, and 8675 pairs of dizygotic twins where IVF was not known to have occurred. The risk for preterm delivery before 32 weeks of gestation was significantly increased among dizygotic twin pairs born after IVF compared with non-IVF dizygotic twin pairs. No significant difference in low birthweight or birthweight difference within twin pairs was seen. There was an increased occurrence of twin pairs with respiratory problems or jaundice, but only the latter diagnosis occurred in a statistically significant excess. Conclusions The study confirms recent findings that IVF is associated with an increased risk for some neonatal complications, not only among singletons but also among twins.
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| 15. |
- Källén, Bengt, et al.
(författare)
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Trends in delivery and neonatal outcome after in vitro fertilization in Sweden: data for 25 years
- 2010
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Ingår i: HUMAN REPRODUCTION. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 25:4, s. 1026-1034
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Tidskriftsartikel (refereegranskat)abstract
- Marked changes have occurred in in vitro fertilization (IVF) methodology during the past 25 years but also in characteristics of couples undergoing treatment. This study was based on 27 386 women undergoing IVF treatment from 1982 to 2006 and giving birth to 31 850 infants. Outcomes of deliveries were studied using Swedish health registers. Comparisons were made with all deliveries in the population (n = 2 603 601). Adjusted odds ratios were calculated when important changes in background rates had occurred. There was a substantial increase in the use of intracytoplasmatic sperm injection (ICSI) and the transfer of cryopreserved embryos. Among all ICSI cases, the proportion using epididymal or testicular sperm varied between 5 and 10%. Maternal characteristics changed during the observation period but the median age remained relatively constant in spite of the increasing maternal age in the population. There was a decline in the rate of some maternal pregnancy diagnoses (notably pre-eclampsia, premature rupture of membranes) and some neonatal diagnoses (notably preterm births, low birthweight, cerebral hemorrhage, respiratory diagnoses, use of continuous positive airway pressure and mechanical ventilation, sepsis/pneumonia). Up till 1992, the twinning rate increased to a maximum of about 30% and then declined to 5% towards the end of the period whereas higher order multiples nearly disappeared. The total rate of infants with congenital malformations changed only little. The decrease in unwanted outcomes can, to a large extent, be explained by the reduced rate of multiple births but was seen also among singletons. Other explanations can be sought in changes in the characteristics of patients undergoing IVF.
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