辅助生殖技术与不良妊娠结局的关联。
Association of assisted reproductive technology with adverse pregnancy outcomes.
作者信息
Jie Zhang, Yiling Ding, Ling Yu
机构信息
Department of Obstetrics and Gynecology , T he Second Xiangya Hospital, Central South University, Changsha, Hunan Province, People ' s Republic of China.
出版信息
Iran J Reprod Med. 2015 Mar;13(3):169-80.
BACKGROUND
More and more infertile patients have accepted the assisted reproductive technique (ART) therapy. Concerns have been raised over an increased risk of adverse maternal outcomes in ART populations as compared with natural conception (NC).
OBJECTIVE
The aim was to improve the ART in clinicial work and to reduce the incidence of pregnancy complications in ART group according to analyzing the reasons of high incidence of pregnancy complications in ART group, comparing the incidence of pregnancy complications in different controlled ovarian hyperstimulation (COH) programs and evaluating the effects of ART which attribute to adverse pregnancy outcomes.
MATERIALS AND METHODS
In this prospective population-based cohort study,3216 pregnant women with gestational age ≤12 weeks, regular antenatal examination,and ultrasound identification of intrauterine pregnancy were enrolled from January 2010 to June 2013. According to having ART history, the participantswere divided into two groups: ART group (contains fresh embryo transfer group or frozen-thawed embryo transfer group) and NC group. We compared the incidence of pregnancy complications between different groups and evaluated the factors which could affect the occurrence of these complications.
RESULTS
When compared to NC group, significantly increased rates of gestational diabetes mellitus (GDM) (p<0.01), preeclampsia (PE) (p<0.01) and intrahepatic cholestasis of pregnancy (ICP) (p˂0.01) were observed in ART group. There was no significant difference in the incidence of birth defect between the two groups (p=0.07). Multiple pregnancies and Gonadotropin (Gn) were risk factors in GDM, PE, and ICP. The exogenous progesterone treatment had no effect on GDM, PE or ICP.
CONCLUSION
ART increases the risk of adverse maternal complications such as GDM, PE and ICP. The dosages of Gn should be reduced to an extent and the number of embryo implantation should be controlled. Exogenous progesterone treatment is safe.
背景
越来越多的不孕患者接受了辅助生殖技术（ART）治疗。与自然受孕（NC）相比，ART人群中孕产妇不良结局风险增加引发了人们的关注。
目的
通过分析ART组妊娠并发症高发的原因，比较不同控制性卵巢刺激（COH）方案中妊娠并发症的发生率，并评估ART对不良妊娠结局的影响，以改进临床工作中的ART并降低ART组妊娠并发症的发生率。
材料与方法
在这项基于人群的前瞻性队列研究中，2010年1月至2013年6月纳入了3216例孕周≤12周、定期产前检查且经超声确认宫内妊娠的孕妇。根据有无ART史，将参与者分为两组：ART组（包括新鲜胚胎移植组或冻融胚胎移植组）和NC组。我们比较了不同组之间妊娠并发症的发生率，并评估了可能影响这些并发症发生的因素。
结果
与NC组相比，ART组妊娠糖尿病（GDM）（p<0.01）、先兆子痫（PE）（p<0.01）和妊娠肝内胆汁淤积症（ICP）（p˂0.01）的发生率显著升高。两组出生缺陷发生率无显著差异（p=0.07）。多胎妊娠和促性腺激素（Gn）是GDM、PE和ICP的危险因素。外源性孕酮治疗对GDM、PE或ICP无影响。
结论
ART增加了GDM、PE和ICP等孕产妇不良并发症的风险。应在一定程度上降低Gn的剂量，并控制胚胎植入数量。外源性孕酮治疗是安全的。
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