Assisted Reproductive Technologies and Offspring's School Grades by Maternal Education

BACKGROUND: Children conceived through assisted reproductive technologies (ART) often achieve higher school grades than spontaneously conceived peers in unadjusted analyses, a pattern largely attributed to the socio-economic advantage of parents who use ART. However, as ART is increasingly utilised by less advantaged groups, it is important to understand how ART-conceived children fare when their parents have lower levels of education. OBJECTIVE: The objective of this study is to examine whether the association between conception through assisted reproductive technologies and school grades at age 16 differs by maternal education. METHODS: We conducted a population-based cohort study of all live-born children in Norway from 1985 to 2002 who completed compulsory schooling (n = 929,017), using nationwide register data. The exposure was conception through ART (1.0%), and the outcome was the standardised grade point average (GPA) at age 16. Analyses were stratified by maternal education (primary/secondary vs. tertiary). Using linear regression models, we estimated differences in GPA between ART- and spontaneously conceived children. We progressively adjusted for child sex, birth cohort, plurality, birth order, maternal age, parental income and family structure. RESULTS: Among children of lower-educated mothers, mean GPA was higher for ART-conceived than spontaneously conceived children in baseline models (0.17, 95% confidence interval [CI] 0.14, 0.19). Among children of tertiary-educated mothers, the corresponding difference was 0.06 (95% CI 0.03, 0.09). After adjustment, the differences were slightly negative but small in magnitude in both education groups (primary/secondary: -0.18, 95% CI -0.21, -0.16; tertiary: -0.08, 95% CI -0.11, -0.05). CONCLUSIONS: Both ART-conceived children of less- and more-educated mothers appear advantaged in unadjusted analyses. After accounting for parental characteristics, differences were small in both education groups, reflecting socio-demographic selection into treatment within each group. These findings suggest that as ART use expands across more socio-economically diverse populations, it is unlikely to independently improve or worsen children's school performance across educational strata.