Division of Maternal Fetal Medicine, Ultrasound and Genetics, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA.
Am J Perinatol. 2011 May;28(5):347-54. doi: 10.1055/s-0030-1268707. Epub 2010 Nov 16.
We evaluated the impact of assisted reproductive technology (ART) on the association between first-trimester pregnancy-associated plasma protein A (PAPP-A) and human chorionic gonadotropin (β-hCG) and adverse pregnancy outcomes. PAPP-A and β-hCG levels were obtained between 11 and 13 (6)/ (7) weeks' gestation and converted to multiples of the median (MoM). MoM < 5th percentile was defined as low PAPP-A or β-hCG and those > 90th percentile as high. Adverse outcomes included small-for-gestational-age (SGA) infants, preeclampsia, pregnancy loss, and preterm delivery (PTD). Univariate and multivariate analyses were used to estimate the association. Of 4000 women meeting the inclusion criteria, 265 (7.6%) pregnancies were conceived by ART. ART pregnancies with low PAPP-A had a higher risk of having an SGA infant (odds ratio [OR] = 4.1, 95% confidence interval [CI] 1.2, 14.0) or PTD < 32 weeks (OR = 5.3, 95% CI 1.5, 18.6) compared with non-ART pregnancies with low PAPP-A (OR = 2.8, 95% CI 1.7, 4.7; OR = 3.9, 95% CI 2.1, 7.0, respectively). High PAPP-A was associated with pregnancy loss (OR = 6.1, 95% CI 1.1, 33.7) in ART pregnancies. Low β-hCG was associated with increased risk for PTD only in ART pregnancies (OR = 8.3, 95% CI 1.9, 35.9) for PTD < 37 weeks (OR 6.1, 95% CI 1.6, 23.0) for PTD < 35 weeks and (OR = 10.8, 95% CI 2.7, 43.7) for PTD < 32 weeks. High β-hCG was associated with increased risk for SGA (OR = 1.6, 95% CI 1.0, 2.5) and PTD < 37 weeks (OR = 1.4, 95% CI 1.0, 1.9) in non-ART pregnancies. The association between PAPP-A and β-hCG with adverse pregnancy outcomes is influenced by the mode of conception.
我们评估了辅助生殖技术（ART）对早孕期妊娠相关血浆蛋白 A（PAPP-A）和人绒毛膜促性腺激素（β-hCG）与不良妊娠结局之间关联的影响。在 11-13 （6）/（7）孕周时获得 PAPP-A 和 β-hCG 水平，并转换为中位数倍数（MoM）。MoM＜第 5 百分位数定义为低 PAPP-A 或 β-hCG，MoM＞第 90 百分位数定义为高 PAPP-A 或 β-hCG。不良结局包括小于胎龄儿（SGA）、子痫前期、妊娠丢失和早产（PTD）。使用单变量和多变量分析来估计相关性。在符合纳入标准的 4000 名女性中，265 名（7.6%）妊娠通过 ART 受孕。ART 妊娠中低 PAPP-A 与 SGA 婴儿（比值比[OR] = 4.1，95%置信区间[CI] 1.2，14.0）或 PTD＜32 周（OR = 5.3，95% CI 1.5，18.6）的风险更高与非 ART 妊娠中低 PAPP-A（OR = 2.8，95% CI 1.7，4.7；OR = 3.9，95% CI 2.1，7.0）相比。ART 妊娠中高 PAPP-A 与妊娠丢失（OR = 6.1，95% CI 1.1，33.7）相关。低 β-hCG 仅与 ART 妊娠的 PTD 相关（OR = 8.3，95% CI 1.9，35.9），对于 PTD＜37 周（OR 6.1，95% CI 1.6，23.0），对于 PTD＜35 周（OR = 10.8，95% CI 2.7，43.7），对于 PTD＜32 周。非 ART 妊娠中高 β-hCG 与 SGA（OR = 1.6，95% CI 1.0，2.5）和 PTD＜37 周（OR = 1.4，95% CI 1.0，1.9）的风险增加相关。妊娠相关血浆蛋白 A（PAPP-A）和β-hCG 与不良妊娠结局之间的关联受受孕方式的影响。
