Fertility and IVF Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
High Risk Pregnancy Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Int J Gynaecol Obstet. 2018 Jan;140(1):98-104. doi: 10.1002/ijgo.12345. Epub 2017 Nov 1.
To compare perinatal outcomes between spontaneous conception and assisted reproductive technologies (ART) among patients of advanced maternal age.
The present retrospective study included data from singleton pregnancies of women aged at least 40 years who delivered between January 1, 1991, and December 31, 2013, at Soroka University Medical Center, Beer Sheva, Israel. Demographic, obstetric, and perinatal data were compared between pregnancies conceived with ART (in vitro fertilization [IVF] or ovulation induction) and those conceived spontaneously. Multiple regression models were used to define independent predictors of adverse outcomes.
A total of 8244 singleton pregnancies were included; 229 (2.8%) following IVF, 86 (1.0%) following ovulation induction, and 7929 (96.2%) were spontaneous. Preterm delivery (P<0.001), fetal growth restriction (FGR) (P<0.001), and cesarean delivery (P<0.001) demonstrated linear associations with the conception mode; the highest rates for each were observed for IVF, with decreased rates for ovulation induction and spontaneous conception. The incidence of gestational diabetes and hypertensive disorders were highest among pregnancies following ART. No association was observed between conception mode and perinatal mortality. Multivariate logistic regression demonstrated that IVF was independently associated with increased odds of preterm delivery (P<0.001) and FGR (P=0.027) compared with spontaneous conception.
Among patients of advanced maternal age, ART were independently associated with increased FGR and preterm delivery rates compared with spontaneous pregnancies; perinatal mortality was comparable.
比较高龄产妇中自然受孕与辅助生殖技术（ART）的围产结局。
本回顾性研究纳入了 1991 年 1 月 1 日至 2013 年 12 月 31 日期间在以色列贝尔谢巴索罗卡大学医学中心分娩的至少 40 岁的单胎妊娠患者的数据。比较了采用 ART（体外受精[IVF]或诱导排卵）受孕与自然受孕的妊娠患者的人口统计学、产科和围产儿数据。采用多元回归模型确定不良结局的独立预测因素。
共纳入 8244 例单胎妊娠；其中 229 例（2.8%）采用 IVF，86 例（1.0%）采用诱导排卵，7929 例（96.2%）为自然受孕。早产（P<0.001）、胎儿生长受限（FGR）（P<0.001）和剖宫产（P<0.001）与受孕方式呈线性相关；IVF 的发生率最高，诱导排卵和自然受孕的发生率逐渐降低。妊娠后发生妊娠期糖尿病和高血压疾病的发生率在采用 ART 的妊娠中最高。受孕方式与围产儿死亡率之间无相关性。多变量逻辑回归显示，与自然受孕相比，IVF 与早产（P<0.001）和 FGR（P=0.027）的几率增加独立相关。
在高龄产妇中，与自然受孕相比，ART 与 FGR 和早产发生率增加独立相关；围产儿死亡率相当。
