Higher long-term healthcare utilization in children conceived through medically assisted reproduction: findings from a 16-year cohort study.

Abstract

The use of medically assisted reproduction is increasing over time, and there are limited data on the long-term health services use associated with medically assisted reproduction. This study aimed to examine the long-term healthcare service use and prescription medication use in children who were conceived through medically assisted reproduction and to compare it with that of naturally conceived children. Data from Growing up in Australia: Longitudinal Study of Australian Children, a population-based longitudinal cohort study, linked with Australian Medicare administrative records, were used for this study. Out-of-hospital healthcare service use and costs, including prescription medication use, were compared between children who conceived with and those who were conceived without medically assisted reproduction. Generalized linear models and logistic models were applied to investigate the association of medically assisted reproduction with total healthcare costs and the use of prescription medications with adjustment for a wide range of birth, pregnancy, and socioeconomic characteristics. The study included 4789 singleton children who were followed from birth to the age 16 years with 246 of them conceived through medically assisted reproduction. Higher healthcare use and costs were seen for children who were conceived through medically assisted reproduction when compared with naturally conceived children across all age bands, except for ages 10 to 11 years, and the differences were statistically significant for ages 2 to 3 years (mean difference, $87.53; 95% confidence interval, $8.87-$166.19) and for ages 4 to 5 years (mean difference, $117.53; 95% confidence interval, $30.95-$204.11) after controlling for birth, pregnancy conditions, and socioeconomic characteristics. Among all available age bands, children aged 6 to 15 years who were conceived through medically assisted reproduction were found to have 2.41 (95% confidence interval, 1.15-5.08) to 3.20 (95% confidence interval, 1.54-6.64) times the odds of being prescribed attention-deficit/hyperactivity disorder medications than naturally conceived children after controlling for birth, pregnancy, and socioeconomic characteristics. In terms of mental health medications, children who were conceived through medically assisted reproduction had 5.24 (95% confidence interval, 2.02-13.58) and 2.96 (95% confidence interval, 1.23-7.13) times the odds of being prescribed these medications than naturally conceived children for the age bands 4 to 5 and 6 to 7 years, respectively, after adjusting for covariates. Little to no differences were observed in the use of prescriptions for adrenaline autoinjectors, asthma medications, eczema medications, anti-infectives medications (antiviral, antibacterial, antifungal), or other medications between children conceived through medically assisted reproduction and those conceived naturally. This study highlights a higher need for long-term healthcare services and associated resources for children who were conceived through medically assisted reproduction, which cannot be explained by socioeconomic-related parental health-seeking behaviors and perinatal factors, like multiple births and birth weight. This study helps to anticipate the downstream financial impact on 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 through medically assisted reproduction.