体外受精受孕新生儿的卵巢刺激和低出生体重。
Ovarian stimulation and low birth weight in newborns conceived through in vitro fertilization.
机构信息
Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Obstet Gynecol. 2011 Oct;118(4):863-71. doi: 10.1097/AOG.0b013e31822be65f.
OBJECTIVE
Singleton neonates born after in vitro fertilization (IVF) are at increased risk for low birth weight, preterm delivery, or both. We sought to assess whether the alteration of the peri-implantation maternal environment resulting from ovarian stimulation may contribute to increased risk of low birth weight in IVF births.
METHODS
The Society for Assisted Reproductive Technologies database was used to identify IVF-conceived neonates born in the United States between 2004 and 2006. Associations were assessed in neonates born after fresh compared with frozen and thawed embryo transfer in women of similar ovarian responsiveness, in paired analysis of neonates born to the same woman after both types of embryo transfer, and in neonates born after oocyte donation.
RESULTS
Of 56,792 neonates identified, 38,626 and 18,166 were conceived after transfer of fresh and frozen embryos, respectively. In singletons, there was no difference in preterm delivery. However, the odds of overall low birth weight (10% compared with 7.2%; adjusted odds ratio [OR] 1.35; 95% confidence interval [CI] 1.20-1.51), low birth weight at term (2.5% compared with 1.2%, adjusted OR 1.73, 95% CI 1.31-2.29), and preterm low birth weight (34.1% compared with 23.8%, adjusted OR 1.49, 95% CI 1.24-1.78) were all significantly higher after fresh embryo transfer. In singletons, after either fresh or frozen embryo transfer in the same patient, this association was even stronger (low birth weight: 11.5% compared with 5.6%, adjusted OR 4.66, 95% CI 1.18-18.38). In oocyte donor recipients who do not undergo any ovarian hormonal stimulation for either a fresh or a frozen embryo transfer, no difference in low birth weight was demonstrated (11.5% compared with 11.3% adjusted OR 0.99, 95% CI 0.82-1.18).
CONCLUSION
The ovarian stimulation-induced maternal environment appears to represent an independent mediator contributing to the risk of low birth weight, but not preterm delivery, in neonates conceived after IVF.
LEVEL OF EVIDENCE
II.
目的
体外受精（IVF）后出生的单胎新生儿体重低、早产或两者兼而有之的风险增加。我们试图评估卵巢刺激导致的围植入期母体环境改变是否会增加 IVF 出生的低体重儿风险。
方法
利用美国辅助生殖技术协会数据库，鉴定了 2004 年至 2006 年在美国出生的 IVF 新生儿。在卵巢反应性相似的女性中，比较新鲜胚胎与冷冻和解冻胚胎移植的新生儿，在同种胚胎移植的同一女性的新生儿配对分析，以及在卵母细胞捐赠后的新生儿，评估关联。
结果
在 56792 名新生儿中，分别有 38626 名和 18166 名新生儿是新鲜胚胎和冷冻胚胎移植后出生的。在单胎中，早产没有差异。然而，总体低体重儿（10%与 7.2%，调整后的优势比[OR]1.35；95%置信区间[CI]1.20-1.51）、足月低体重儿（2.5%与 1.2%，调整后的 OR 1.73，95% CI 1.31-2.29）和早产低体重儿（34.1%与 23.8%，调整后的 OR 1.49，95% CI 1.24-1.78）的风险均显著升高新鲜胚胎移植后。在单胎中，新鲜胚胎或冷冻胚胎在同一患者中转移后，这种关联甚至更强（低体重儿：11.5%与 5.6%，调整后的 OR 4.66，95% CI 1.18-18.38）。对于新鲜或冷冻胚胎转移均未接受任何卵巢激素刺激的卵母细胞供体接受者，低体重儿无差异（11.5%与调整后的 OR 0.99，95% CI 0.82-1.18）。
结论
卵巢刺激引起的母体环境似乎是导致 IVF 后新生儿低体重但不早产的独立中介因素。
证据水平
II 级。
Zotero 插件