Fertility Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Acta Obstet Gynecol Scand. 2018 Jul;97(7):816-823. doi: 10.1111/aogs.13347. Epub 2018 Apr 14.
Children born after assisted reproductive technology, particularly singletons, have been shown to have an increased risk of congenital malformations compared with children born after spontaneous conception. We wished to study whether there has been a change in the past 20 years in the risk of major congenital malformations in children conceived after assisted reproductive technology compared with children spontaneously conceived.
Population-based cohort study including 90 201 assisted reproductive technology children and 482 552 children spontaneously conceived, born in Denmark, Finland, Norway and Sweden. Both singletons and twins born after in vitro fertilization, intracytoplasmatic sperm injection and frozen embryo transfer were included. Data on children were taken from when the national Nordic assisted reproductive technology registries were established until 2007. Multiple logistic regression analyses were used to estimate the risks and adjusted odds ratios for congenital malformations in four time periods: 1988-1992, 1993-1997, 1998-2002 and 2003-2007. Only major malformations were included.
The absolute risk for singletons of being born with a major malformation was 3.4% among assisted reproductive technology children vs. 2.9% among children spontaneously conceived during the study period. The relative risk of being born with a major congenital malformation between all assisted reproductive technology children and children spontaneously conceived remained similar through all four time periods (p = 0.39). However, we found that over time the number of children diagnosed with a major malformation increased in both groups across all four time periods.
When comparing children conceived after assisted reproductive technology and spontaneously conceived, the relative risk of being born with a major congenital malformation did not change during the study period.
与自然受孕所生育的儿童相比，通过辅助生殖技术（assisted reproductive technology，ART）出生的儿童，尤其是单胎，其先天畸形的风险有所增加。我们希望研究在过去 20 年中，与自然受孕所生育的儿童相比，通过辅助生殖技术受孕的儿童其主要先天畸形的风险是否发生了变化。
这是一项基于人群的队列研究，纳入了 90201 名通过辅助生殖技术出生的儿童和 482552 名自然受孕出生的儿童，他们均来自丹麦、芬兰、挪威和瑞典。研究纳入了体外受精（in vitro fertilization，IVF）、卵胞浆内单精子注射（intracytoplasmatic sperm injection，ICSI）和冻融胚胎移植（frozen embryo transfer，FET）后出生的单胎和双胎。研究数据来源于北欧辅助生殖技术注册中心成立至 2007 年。采用多因素逻辑回归分析方法，在四个时间区间（1988-1992 年、1993-1997 年、1998-2002 年和 2003-2007 年）中评估了儿童先天畸形的风险和校正比值比（adjusted odds ratio，aOR）。仅纳入了主要畸形。
在研究期间，与自然受孕所生育的儿童相比，通过辅助生殖技术出生的单胎儿童发生重大畸形的绝对风险为 3.4%，而自然受孕所生育的儿童为 2.9%。所有通过辅助生殖技术出生的儿童与自然受孕所生育的儿童之间发生主要先天畸形的相对风险在四个时间区间内均相似（p = 0.39）。然而，我们发现随着时间的推移，两个组的儿童中被诊断为重大畸形的数量在所有四个时间区间内均有所增加。
在比较通过辅助生殖技术受孕的儿童与自然受孕所生育的儿童时，在研究期间，其发生主要先天畸形的相对风险并未发生变化。
