辅助生殖技术后的神经发育结局
Neurodevelopmental Outcomes After Assisted Reproductive Technologies.
作者信息
Balayla Jacques, Sheehy Odile, Fraser William D, Séguin Jean R, Trasler Jacquetta, Monnier Patricia, MacLeod Andrea A, Simard Marie-Noëlle, Muckle Gina, Bérard Anick
机构信息
Departments of Obstetrics and Gynecology and Psychiatry and the School of Rehabilitation and the Faculty of Pharmacy, University of Montreal, the Research Unit on Medications and Pregnancy, Research Center, CHU Sainte-Justine, the Departments of Pediatrics, Human Genetics, and Pharmacology & Therapeutics, McGill University, Montreal Children's Hospital and Research Institute of the McGill University Health Centre, the Department of Obstetrics and Gynecology, Research Institute of the McGill University Health Center, and École d'orthophonie et d'audiologie, Université de Montréal, Montréal, the Department of Obstetrics and Gynecology, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, and the School of Psychology, Laval University, and the Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, Québec City, Québec, Canada.
出版信息
Obstet Gynecol. 2017 Feb;129(2):265-272. doi: 10.1097/AOG.0000000000001837.
OBJECTIVE
To compare children's cognitive, motor, and language development at 2 years of age after assisted reproductive technologies (ARTs) relative to natural conception.
METHODS
The 3D-Study (2010-2012) is a prospective cohort study, which sought to improve the understanding among perinatal events, obstetric outcomes, and child development. A total of 2,366 pregnant women were recruited, of whom 278 conceived with ART: ovarian stimulation, intrauterine sperm insemination, in vitro fertilization, intracytoplasmic sperm injection, or in vitro maturation. Natural conception was defined as the unassisted establishment of pregnancy. Cognitive, motor, and language neurodevelopmental outcomes were compared between ART and natural conception groups at 24 months using the Bayley Scales of Infant and Toddler Development, 3rd edition, and the MacArthur-Bates Communicative Development Inventories. Adjusted linear regression models evaluated the effect of ART on neurodevelopmental outcomes using natural conception as a reference.
RESULTS
A total of 175 children in the ART group (62.9%) and 1,345 children in the natural conception group (64.4%) underwent neurodevelopmental assessment at 24 months postpartum. After adjusting for relevant confounders, children born after ART showed no difference in Bayley scales' cognitive scores (B1 [standard error]=-1.60 [0.9], 95% confidence interval [CI] -3.36 to 0.16), composite motor scores (B1 [standard error]=-1.33 [1.0], 95% CI -3.29 to 0.63), or MacArthur-Bates language scores (B1 [standard error]=-0.28 [2.1], 95% CI -4.39 to 3.83). No difference was observed when independent ART techniques were compared nor when comparing in vivo (ovarian stimulation or intrauterine insemination) or in vitro (in vitro fertilization, intracytoplasmic sperm injection, or in vitro maturation) techniques (P>.05).
CONCLUSION
Children born after ART had similar cognitive, motor, and language development as children born after natural conception at 2 years of age. These findings may be useful in the clinical counseling of patients undergoing ART.
目的
比较辅助生殖技术（ART）后2岁儿童与自然受孕儿童在认知、运动和语言发育方面的情况。
方法
3D研究（2010 - 2012年）是一项前瞻性队列研究，旨在增进对围产期事件、产科结局和儿童发育的了解。共招募了2366名孕妇，其中278名通过ART受孕：包括卵巢刺激、宫腔内人工授精、体外受精、卵胞浆内单精子注射或体外成熟。自然受孕定义为未借助辅助手段而怀孕。使用贝利婴幼儿发展量表第3版和麦克阿瑟 - 贝茨交流发展量表，比较ART组和自然受孕组在24个月时的认知、运动和语言神经发育结局。以自然受孕为对照，采用校正线性回归模型评估ART对神经发育结局的影响。
结果
ART组共有175名儿童（62.9%）和自然受孕组1345名儿童（64.4%）在产后24个月接受了神经发育评估。在调整相关混杂因素后，ART出生的儿童在贝利量表的认知得分（B1[标准误]= - 1.60[0.9]，95%置信区间[CI] - 3.36至0.16）、综合运动得分（B1[标准误]= - 1.33[1.0]，95%CI - 3.29至0.63）或麦克阿瑟 - 贝茨语言得分（B1[标准误]= - 0.28[2.1]，95%CI - 4.39至3.83）方面无差异。比较独立的ART技术时，以及比较体内（卵巢刺激或宫腔内人工授精）或体外（体外受精、卵胞浆内单精子注射或体外成熟）技术时，均未观察到差异（P>0.05）。
结论
ART出生的儿童在2岁时的认知、运动和语言发育与自然受孕出生的儿童相似。这些发现可能有助于对接受ART治疗的患者进行临床咨询。
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