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Video

Oral Presentation

Session: It Starts at The Very Beginning

Early-life cancer risk among children conceived by assisted reproductive technology: A comparative nationwide cohort study from the French National Mother-Child Register "EPI-MERES"

Friday, August 25, 2023
2:30 PM - 2:45 PM ADT
Location: MR202
Publication Number: 70
Background: Cancer is a leading cause of death among children worldwide. Assisted reproductive technologies (ART) are suspected risk factors because of their potential for epigenetic disturbance and associated congenital malformations.

Objectives: To assess the risk of cancer among children conceived by ART, compared to those naturally conceived (NC).

Methods: We conducted a nationwide population-based cohort study using comprehensive data from the French National Mother-Child Register “EPI-MERES” built from the National Health Data System. All live births in France from January 1, 2010 to December 31, 2021 were included and followed up until June 30, 2022. The exposure of interest was ART (in-vitro fertilization followed by fresh (fresh-ET) or frozen embryo transfers (FET) or artificial insemination (AI)). Childhood malignancies were identified by hospitalization discharge and grouped into broad categories similar to that of the International Classification of Childhood Cancer. Cox proportional hazards regression models were used to estimate the adjusted hazard ratios (aHR) and their 95% confidence intervals (CI) comparing the risk of first childhood cancer (overall and by cancer type) between children born after fresh-ET, FET or AI and those NC. Adjustment was made for potential confounders including child’s sex, year of birth, multiplicity, maternal age and a social deprivation index. Congenital malformations and foetal growth anomalies were accounted for as potential mediating factors.

Results: Among a total of 8,526,306 children included, 260,236 (3.1%) were born after ART, including 133,965 (1.6%) after fresh-ET, 66,165 (0.8%) after FET and 60,106 (0.7%) after AI. Overall, 9,256 cancers were identified over a median follow-up of 6.1 years: 8,964 among NC children, 165 among children born after fresh-ET, 57 among children born after FET and 70 among children born after AI (Incidence Rate/million PY 164, 183, 172 and 179, respectively). The most common cancer type was leukaemia (NC: 2,635 cases; fresh-ET: 52 cases; FET: 23 cases; AI: 19 cases). Acute lymphoblastic leukaemia (ALL) accounted for 79% of leukaemia cases. The overall risk of cancer among children born after fresh-ET, FET or AI did not differ to that among NC children (aHRs ranging from 1.00 to 1.13). Though, the risk of ALL was higher in children born after FET compared to those NC (FET: 20 cases, NC: 38 cases; aHR 1.60, 95% CI 1.03-2.49).

Conclusions: Our findings suggest that the risk of ALL may be increased among children conceived by FET. Although based on one of the largest cohort on the topic, the number of cancer cases is limited. Continued follow-up of children conceived by ART is warranted to monitor the risk of cancer occurrence on the longer term.