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OBJECTIVE: To examine the effects of pregnancy planning, time to conception (TTC), and assisted reproductive technologies (ART) on child behavior. DESIGN: Prospective cohort study. SETTING: Not 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.

Original publication




Journal article


Fertil Steril

Publication Date





456 - 463


Causality, Child, Child Behavior Disorders, Child, Preschool, Family Planning Services, Female, Humans, Incidence, Infertility, Male, Pregnancy, Reproductive Techniques, Assisted, Risk Factors, United Kingdom