Department of Obstetrics & Gynecology and Pathology, Dartmouth-Hitchcock, One Medical Center Drive, Lebanon, NH, 03756, USA.
Mass Department of Public Health, Boston, MA, USA.
J Assist Reprod Genet. 2018 Sep;35(9):1585-1593. doi: 10.1007/s10815-018-1238-x. Epub 2018 Jun 20.
To determine whether differences in birth outcomes among assisted reproductive technology (ART)-treated, subfertile, and fertile women exist in primiparous women with, singleton, vaginal deliveries.
Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) data were linked to Massachusetts vital records and hospital discharges for deliveries between July 2004 and December 2010. Primiparous women with in-state vaginal deliveries, adequate prenatal care, and singleton birth at ≥ 20 weeks (n = 117,779) were classified as ART-treated (linked to ART data from SART CORS, n = 3138); subfertile (not ART-treated but with indicators of subfertility, n = 1507); or fertile (neither ART-treated nor subfertile, n = 113,134). Outcomes of prematurity (< 37 weeks), low birthweight (< 2500 g), perinatal death (death at ≥ 20 weeks to ≤ 7 days), and maternal prolonged length of hospital stay (LOS > 3 days) were compared using multivariable logistic regression.
Compared to fertile, higher odds were found for prematurity among ART-treated (adjusted odds ratio [AOR] 1.40, 95% confidence interval [CI] 1.25-1.50) and subfertile (AOR 1.25, 95% CI 1.03-1.50) women, low birthweight among ART-treated (AOR 1.41, 95% CI 1.23-1.62) and subfertile (AOR 1.40, 95% CI 1.15-1.71) women, perinatal death among subfertile (AOR 2.64, 95% CI 1.72-4.05), and prolonged LOS among ART-treated (AOR 1.33, 95% CI 1.19-1.48) women. Differences remained despite stratification by young age and absence of pregnancy/delivery complications.
Greater odds of prematurity and low birthweight in ART-treated and subfertile, and perinatal death in subfertile deliveries are evident among singleton vaginal deliveries. The data suggest that even low-risk pregnancies to ART-treated and subfertile women be managed for adverse outcomes.
确定在接受辅助生殖技术（ART）治疗的、不孕的和有生育能力的女性中，初产妇、单胎阴道分娩的女性之间是否存在分娩结局的差异。
将美国生殖医学协会临床结果报告系统（SART CORS）的数据与马萨诸塞州的生命记录和医院分娩记录进行了链接，时间范围为 2004 年 7 月至 2010 年 12 月。本研究纳入了在州内进行阴道分娩、有充分产前护理且孕 20 周以上分娩的单胎初产妇（n=117779），将其分类为 ART 治疗组（与 SART CORS 的 ART 数据相关联，n=3138）、非 ART 治疗但存在不孕因素的亚不孕组（n=1507）或无 ART 治疗且无不孕因素的有生育能力组（n=113134）。使用多变量逻辑回归比较早产（<37 周）、低出生体重（<2500g）、围产期死亡（≥20 周至≤7 天）和产妇住院时间延长（LOS>3 天）的结局。
与有生育能力的女性相比，ART 治疗组（校正优势比 [AOR] 1.40，95%置信区间 [CI] 1.25-1.50）和亚不孕组（AOR 1.25，95% CI 1.03-1.50）发生早产的几率更高，ART 治疗组（AOR 1.41，95% CI 1.23-1.62）和亚不孕组（AOR 1.40，95% CI 1.15-1.71）发生低出生体重的几率更高，亚不孕组（AOR 2.64，95% CI 1.72-4.05）发生围产期死亡的几率更高，ART 治疗组（AOR 1.33，95% CI 1.19-1.48）发生 LOS 延长的几率更高。即使分层为年龄较小和无妊娠/分娩并发症，这些差异仍然存在。
在接受 ART 治疗和亚不孕的初产妇、单胎阴道分娩中，ART 治疗和亚不孕组发生早产和低出生体重的几率更高，亚不孕组发生围产期死亡的几率更高。这些数据表明，即使是 ART 治疗和亚不孕的低风险孕妇，也需要对不良结局进行管理。
