Qin Jiabi, Sheng Xiaoqi, Wang Hua, Liang Desheng, Tan Hongzhuan, Xia Jiahui
Division of Medical Genetics, Maternal and Child Health Hospital of Hunan Province, 53 Xiangchun Road, Changsha, 410008, Hunan, China,
Arch Gynecol Obstet. 2015 Oct;292(4):777-98. doi: 10.1007/s00404-015-3707-0. Epub 2015 Apr 16.
To assess the association between assisted reproductive technology (ART) and risk of congenital malformations (CM) by conducting a meta-analysis of cohort studies.
PubMed, Google Scholar, Cochrane Libraries and Chinese database were searched through August 2014 to identify studies that met pre-stated inclusion criteria. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates. Subgroup analysis was performed to explore potential heterogeneity moderators.
Fifty-seven studies involving 119,874 infants conceived following ART and 1,212,320 infants conceived naturally were included in the analysis. The ART-conceived infants were associated with a higher risk of CM [relative risk (RR) = 1.33; 95 % confidence interval (CI) 1.24-1.43] when compared with those conceived naturally. When data were restricted to singleton births (RR = 1.38; 95 % CI 1.30-1.47), major CM (RR = 1.47; 95 % CI 1.29-1.68), matched/adjusted studies (RR = 1.37; 95 % CI 1.27-1.47) or high quality studies (RR = 1.40; 95 % CI 1.27-1.55), the increased risk of CM still existed in ART pregnancies. Additionally, an increased risk of CM was also found when the ART twin (RR = 1.18; 95 % CI 1.06-1.32) or multiple births (RR = 1.16; 95 % CI 1.05-1.27) were separately compared with spontaneously conceived twin or multiple births. Substantial heterogeneity was observed across studies (I (2) = 68, 44, 39, and 33 % for all infants, singletons, twins and multiples, respectively). Whether confounding factors were matched or adjusted, study quality and sample size as the first three of the most relevant heterogeneity moderators have been identified. No evidence of publication bias was observed (P > 0.10).
The ART-conceived infants have a higher risk of CM compared with those conceived naturally. However, these estimates have to be viewed with caution because of heterogeneity.
通过对队列研究进行荟萃分析，评估辅助生殖技术（ART）与先天性畸形（CM）风险之间的关联。
检索截至2014年8月的PubMed、谷歌学术、Cochrane图书馆和中文数据库，以确定符合预先设定纳入标准的研究。采用固定效应模型或随机效应模型计算总体合并风险估计值。进行亚组分析以探索潜在的异质性调节因素。
分析纳入了57项研究，其中119874名婴儿通过ART受孕，1212320名婴儿自然受孕。与自然受孕的婴儿相比，ART受孕的婴儿患CM的风险更高[相对风险（RR）=1.33；95%置信区间（CI）1.24 - 1.43]。当数据仅限于单胎分娩（RR = 1.38；95% CI 1.30 - 1.47）、主要CM（RR = 1.47；95% CI 1.29 - 1.68）、匹配/调整研究（RR = 1.37；95% CI 1.27 - 1.47）或高质量研究（RR = 1.40；95% CI 1.27 - 1.55）时，ART妊娠中CM风险增加仍然存在。此外，当分别将ART双胎（RR = 1.18；95% CI 1.06 - 1.32）或多胎分娩（RR = 1.16；95% CI 1.05 - 1.27）与自然受孕的双胎或多胎分娩进行比较时，也发现CM风险增加。各研究间观察到显著异质性（所有婴儿、单胎、双胎和多胎的I²分别为68%、44%、39%和33%）。已确定混杂因素是否匹配或调整、研究质量和样本量是最相关的异质性调节因素中的前三位。未观察到发表偏倚的证据（P > 0.10）。
与自然受孕的婴儿相比，ART受孕的婴儿患CM的风险更高。然而，由于存在异质性，这些估计值必须谨慎看待。
