Effects of pregnancy planning, fertility, and assisted reproductive treatment on child behavioral problems at 5 and 7 years: evidence from the Millennium Cohort Study

ObjectiveTo examine the effects of pregnancy planning, time to conception (TTC), and assisted reproductive technologies (ART) on child behavior.DesignProspective cohort study.SettingNot applicable.Patient(s)A total of 12,380 singletons recruited at 9 months and followed-up at 5 and 7 years. Conceptions were divided into “unplanned” (unplanned, unhappy), “mistimed” (unplanned, happy), “planned” (planned, TTC <12 months), “subfertile” (planned, TTC ≥12 months), “ovulation induced” (received clomiphene citrate), and “ART” (IVF or intracytoplasmic sperm injection).Intervention(s)None.Main Outcome Measure(s)Child behavior (Strengths and Difficulties Questionnaire [SDQ]).Result(s)Mistimed and unplanned children had higher average SDQ scores at age 5 and 7 years and were significantly more likely to have a clinically relevant behavioral problem compared with the planned group. The ART children had significantly higher average SDQ scores at both 5 and 7 years compared with the planned group. An increase in clinically relevant behavioral problems was observed at 5 years (odds ratio 2.05 [95% confidence interval 0.96, 4.42]) but failed to reach statistical significance. No effects were observed in the subfertile and ovulation-induced groups.Conclusion(s)Unplanned and mistimed children exhibit more behavioral problems than their planned peers. Though ART children have higher mean total difficulties scores, this did not translate into a statistically significant increase in clinically relevant behavioral problems.