title: Mental health and developmental outcomes for children born after ART: a comparative prospective study on child gender and treatment type.
abstract: OBJECTIVE
  Do children born after assisted reproductive techniques (ART; IVF/ICSI) display more mental health issues or social and cognitive developmental problems at 7-8 years than naturally conceived (NC) controls, and does child gender play a role?
  
  
  CONCLUSIONS
  ART children do not differ with regard to mental health or social and cognitive developmental problems when compared with controls, but some gender-specific differences do exist.
  
  
  BACKGROUND
  Systematic reviews have not found any evidence of delays in neurocognitive or sensorimotor development in ART children. However findings on the effect of the type of ART treatment (IVF versus ICSI) on the offspring's physical and mental development have not been uniform. Knowledge of the role of child gender in ART research is scarce.
  
  
  METHODS
  This prospective follow-up study compares mental health and social and cognitive developmental problems between 7-8-year-old ART and NC children, controlling for the father's age, length of the parents' partnership, mother's parity, child's gestational age, and the need of neonatal intensive care unit (NICU). Further, within the ART group, we analysed whether the treatment type (IVF versus ICSI) and the child's gender are associated with the mental health and developmental outcomes.
  
  
  METHODS
  In this study, 255 singleton ART children (IVF and ICSI) were compared with 278 NC children on parent-reported internalizing and externalizing symptoms, and social (social skills and peer relations) and cognitive development (executive functioning, perception, memory, and language). Within the ART group, 164 IVF and 76 ICSI children were compared on the same outcomes. Statistics included analyses of covariates (ANCOVA) with group main effects, group and gender interaction effects, and Bonferroni post hoc tests.
  
  
  RESULTS
  ART and NC children did not differ generally in terms of their internalizing and externalizing symptoms or in the number of social and cognitive developmental problems (Group main effects, P > 0.05), but gender-specific group differences existed. The ART boys showed lower levels of cognitive problems than the NC boys, whereas ART girls showed higher levels of cognitive problems than the NC girls (Group × Gender-interaction effects with Bonferroni post hoc tests on mother-reports, P < 0.01). Further, unlike in the NC group, where boys showed more externalizing symptoms and social and cognitive developmental problems than girls (Group × Gender-interaction effects with Bonferroni post hoc tests for both parents' reports, P < 0.05), gender differences were not found in the ART group. Within the ART group, IVF and ICSI children did not differ in terms of mental health or developmental outcomes, and no significant gender differences emerged.
  
  
  CONCLUSIONS
  The information on children's mental health and development was based on parental reports only. The dropout rate between the child's first year and the school age assessments was very high for fathers (57.4%) and substantial for mothers (30.1%), and the participating group was biased for older age of both parents and for better education of the fathers.
  
  
  CONCLUSIONS
  The findings indicate the importance of considering child gender in learning about multiple developmental outcomes among children born after ART.
  
  
  BACKGROUND
  This study was supported by the Academy of Finland (#11232276), the Emil Aaltonen Foundation, The Family Federation of Finland, Helsinki University Central Hospital Research Funds, and the National Graduate School of Psychology. None of authors has any competing interests to declare.
authors.affiliation: School of Social Sciences and Humanities, Department of Psychology, University of Tampere, Tampere, Finland raija-leena.punamaki@uta.fi.
authors.forename: Raija-Leena
authors.initials: RL
authors.lastname: Punamäki
authors.affiliation: Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Finland University of Helsinki, Helsinki, Finland.
authors.forename: Aila
authors.initials: A
authors.lastname: Tiitinen
authors.affiliation: School of Social Sciences and Humanities, Department of Psychology, University of Tampere, Tampere, Finland.
authors.forename: Jallu
authors.initials: J
authors.lastname: Lindblom
authors.affiliation: Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Finland University of Helsinki, Helsinki, Finland.
authors.forename: Leila
authors.initials: L
authors.lastname: Unkila-Kallio
authors.affiliation: School of Social Sciences and Humanities, Department of Psychology, University of Tampere, Tampere, Finland.
authors.forename: Marjo
authors.initials: M
authors.lastname: Flykt
authors.affiliation: School of Social Sciences and Humanities, Department of Psychology, University of Tampere, Tampere, Finland.
authors.forename: Mervi
authors.initials: M
authors.lastname: Vänskä
authors.affiliation: Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Finland University of Helsinki, Helsinki, Finland.
authors.forename: Piia
authors.initials: P
authors.lastname: Poikkeus
authors.affiliation: Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Maija
authors.initials: M
authors.lastname: Tulppala
mesh_terms: D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology / Q000209:etiology*; D002657:Child Development / Q000502:physiology*; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects* / Q000706:statistics & numerical data; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012737:Sex Factors; D012919:Social Behavior; D020554:Sperm Injections, Intracytoplasmic / Q000009:adverse effects / Q000706:statistics & numerical data
keywords: ART; ICSI; IVF; cognitive development; mental health; school-age children; social development