Shechter-Maor Gil, Czuzoj-Shulman Nicholas, Spence Andrea R, Abenhaim Haim Arie
Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Pav H, Room 325, 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada.
Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada.
Arch Gynecol Obstet. 2018 Jun;297(6):1397-1403. doi: 10.1007/s00404-018-4694-8. Epub 2018 Feb 15.
Our study objective is to examine the association between births conceived with assisted reproductive technology (ART) and birth defects using a large database from the United States.
Using the Centers for Disease Control and Prevention's Period-linked birth-infant death data files and fetal death database for 2011-2013, we conducted a retrospective cohort study comprised of live births that occurred in the USA during that time. Multivariate logistic regression was used to estimate the association between ART and birth defects, both overall and by specific defects.
There were 11,862,780 live births between 2011 and 2013. Of these births, 11,791,730 were spontaneous pregnancies and 71,050 were conceived by ART, with an increasing trend in incidence of ART during the study period and an overall increasing trend of birth defects. Overall, infants conceived by ART had a greater risk of having birth defects than did infants conceived spontaneously (77/10,000 vs 25/10,000, respectively, OR 2.14, 95% CI 1.94-2.35). The malformations most commonly associated with ART were cyanotic heart defects (OR 2.74, 95% CI 2.42-3.09), cleft lip and/or palate (OR 1.47, 95% CI 1.14-1.89), and hypospadias (OR 1.77, 95% CI 1.42-2.19). There were no differences in risk of omphalocele or neural tube defects between the two groups.
There is an overall and type-specific increased risk of birth defects in the ART population. Appropriate counseling and specialized ultrasound evaluations should be considered in pregnancies conceived by ART.
我们的研究目标是利用美国的一个大型数据库，研究辅助生殖技术（ART）受孕与出生缺陷之间的关联。
我们使用疾病控制与预防中心2011 - 2013年的期间关联出生-婴儿死亡数据文件和胎儿死亡数据库，进行了一项回顾性队列研究，该研究包括那段时间在美国发生的活产。采用多变量逻辑回归来估计ART与出生缺陷之间的关联，包括总体关联以及按特定缺陷类型的关联。
2011年至2013年期间共有11,862,780例活产。在这些出生案例中，11,791,730例为自然受孕，71,050例为ART受孕，在研究期间ART的发生率呈上升趋势，出生缺陷总体也呈上升趋势。总体而言，ART受孕的婴儿患出生缺陷的风险高于自然受孕的婴儿（分别为77/10,000和25/10,000，比值比2.14，95%置信区间1.94 - 2.35）。与ART最常相关的畸形是青紫型心脏缺陷（比值比2.74，95%置信区间2.42 - 3.09）、唇裂和/或腭裂（比值比1.47，95%置信区间1.14 - 1.89）以及尿道下裂（比值比1.77，95%置信区间1.42 - 2.19）。两组之间脐膨出或神经管缺陷的风险没有差异。
ART人群中出生缺陷的总体风险和特定类型风险均有所增加。对于ART受孕的孕妇，应考虑进行适当的咨询和专业的超声评估。
