Centers for Disease Control and Prevention and the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
Obstet Gynecol. 2015 Jan;125(1):70-78. doi: 10.1097/AOG.0000000000000584.
To assess national trends in ectopic pregnancy incidence among assisted reproductive technology users and identify risk factors associated with ectopic pregnancy.
We identified 553,577 pregnancies reported to the National ART Surveillance System between 2001 and 2011. Of those, 9,480 were ectopic, of which 485 were heterotopic. As a result of small numbers, ectopic and heterotopic pregnancies were combined for analysis. We assessed temporal trends in annual ectopic pregnancy rates using Poisson regression. We used log-binomial regression models with generalized estimating equations for correlated outcomes within clinics to calculate unadjusted and adjusted risk ratios for the association between ectopic pregnancy and selected patient characteristics and treatment factors.
The rate of ectopic pregnancy declined from 2.0% (n=735, 95% confidence interval [CI] 1.9-2.2) in 2001 to 1.6% (n=968, 95% CI 1.5-1.7) in 2011 (P for trend <.001). The ectopic pregnancy rate ranged from 2.0% (n=7,469, 95% CI 1.9-2.0) for fresh, nondonor cycles to 1.0% (n=641, 95% CI 0.9-1.1) for fresh, donor cycles. Among fresh, nondonor cycles, the rate of ectopic pregnancy was 1.6% (95% CI 1.4-1.7) when one embryo was transferred compared with 1.7% (95% CI 1.7-1.8), 2.2% (95% CI 2.1-2.3), and 2.5% (95% CI 2.4-2.6) when two, three, or four or more embryos were transferred, respectively (adjusted risk ratios 1.11, 95% CI 0.94-0.30; 1.33, 95% CI 1.12-1.56; and 1.49, 95% CI 1.25-1.78).
Ectopic pregnancy incidence after assisted reproductive technology has decreased over time, but factors such as multiple embryo transfer increase the risk of ectopic pregnancy.
II.
评估辅助生殖技术使用者中异位妊娠发生率的国家趋势，并确定与异位妊娠相关的风险因素。
我们在 2001 年至 2011 年间，从全国辅助生殖技术监测系统中确定了 553577 例妊娠病例。其中 9480 例为异位妊娠，其中 485 例为异位妊娠。由于数量较少，将异位妊娠和异位妊娠合并进行分析。我们使用泊松回归评估每年异位妊娠率的时间趋势。我们使用广义估计方程对诊所内相关结局进行对数二项式回归模型，计算异位妊娠与选定患者特征和治疗因素之间关联的未经调整和调整后的风险比。
异位妊娠率从 2001 年的 2.0%（n=735，95%置信区间[CI] 1.9-2.2）下降到 2011 年的 1.6%（n=968，95%CI 1.5-1.7）（趋势 P <.001）。异位妊娠率范围从新鲜、非供体周期的 2.0%（n=7469，95%CI 1.9-2.0）到新鲜、供体周期的 1.0%（n=641，95%CI 0.9-1.1）。在新鲜、非供体周期中，当转移一个胚胎时，异位妊娠率为 1.6%（95%CI 1.4-1.7），而转移两个、三个或四个或更多胚胎时，分别为 1.7%（95%CI 1.7-1.8）、2.2%（95%CI 2.1-2.3）和 2.5%（95%CI 2.4-2.6）（调整后的风险比分别为 1.11，95%CI 0.94-0.30；1.33，95%CI 1.12-1.56；和 1.49，95%CI 1.25-1.78）。
随着时间的推移，辅助生殖技术后的异位妊娠发生率有所下降，但如多胚胎转移等因素会增加异位妊娠的风险。
II 级。
