Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Firouzeh St., South Vali- Asr Ave., Vali- Asr Sq., Tehran, 15937-16615, Iran.
Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Number 12, East Hafez Avenue, Bani Hashem Street, Resalat Highway, Tehran, 16635-148, Iran.
BMC Pregnancy Childbirth. 2018 Dec 14;18(1):495. doi: 10.1186/s12884-018-2115-4.
Growing evidence indicates that the risk of obstetric and perinatal outcomes is higher in women with assisted reproductive technology (ART). However, there is little known about pregnancy related complications and co-morbidity in gestational diabetes mellitus (GDM) following singleton pregnancies achieved by ART in comparison with spontaneous conception (SC).
Two hundred sixty singleton pregnant women conceived by ART and 314 pregnant women conceived by spontaneous conception (SC) were participated in this prospective cohort study. All participants were enrolled after GDM screening through one-step oral glucose tolerance test (OGTT) and then grouped into GDM and non-GDM groups. Women were followed for pregnancy outcomes including pregnancy-induced hypertension (PIH), preeclampsia, antepartum hemorrhage (APH), cesarean section (CS), preterm birth (PTB), intrauterine growth restriction (IUGR), being small or large for gestational age (SGA or LGA), macrosomia, low birth weight (LBW), respiratory distress, neonatal hypoglycemia, NICU admission and perinatal mortality from antenatal visits to delivery. Confounding factors were adjusted in logistic regression model in order to estimate adjusted odds ratios (aORs).
Among 260 ART and 314 SC, 135 and 152 women were GDM women, respectively. Higher maternal age and pre-gravid BMI, shorter duration of gestation and lower gestational weight gain were observed in GDM groups (ART-GDM and SC-GDM) compared to those of the SC group. ART-GDM group had a higher risk (95% confidence interval) of obstetric complications including PIH [aOR:7.04 (2.24-22.15)], preeclampsia [aOR:7.78 (1.62-37.47)], APH [aOR:3.46 (1.28-9.33)], emergency CS [aOR:2.64 (1.43-4.88)], and perinatal outcomes such as PTB [aOR:3.89 (1.51-10.10)], LBW [aOR:3.11 (1.04-9.30)] and NICU admission [aOR:4.36 (1.82-10.45)], as well as neonatal hypoglycemia [aOR: 4.91 (1.50-16.07)], compared to SC group. SC-GDM group showed a higher risk of PIH [aOR: 4.12 (1.31-12.89)], emergency CS [aOR: 2.01 (1.09-3.73] and LGA [aOR: 5.20 (1.07-25.20)], compared to SC group. Additionally, ART group had a higher risk of PIH [aOR: 3.46(1.02-11.68), preeclampsia 5.29 (1.03-27.09), and NICU admission [aOR: 2.53 (1.05-6.09)] compared to SC. Insulin requirement (41.8% vs. 25.7%) was significantly higher in ART-GDM group compared to SC-GDM group.
The findings of this study suggest that GDM occurring after ART conception increases the risk of adverse obstetric and perinatal outcomes.
越来越多的证据表明，辅助生殖技术（ART）受孕的女性发生产科和围产期结局的风险更高。然而，与自然受孕（SC）相比，ART 受孕后发生的妊娠糖尿病（GDM）相关并发症和合并症在单胎妊娠中鲜为人知。
本前瞻性队列研究纳入了 260 名通过 ART 受孕的单胎孕妇和 314 名通过 SC 受孕的孕妇。所有参与者均通过一步口服葡萄糖耐量试验（OGTT）筛查 GDM 后入组，并分为 GDM 和非 GDM 组。对孕妇进行随访，观察妊娠结局，包括妊娠高血压（PIH）、子痫前期、产前出血（APH）、剖宫产（CS）、早产（PTB）、宫内生长受限（IUGR）、小于胎龄儿或大于胎龄儿（SGA 或 LGA）、巨大儿、低出生体重（LBW）、呼吸窘迫、新生儿低血糖、新生儿重症监护病房（NICU）入住和围产儿死亡。为了估计调整后的优势比（aOR），采用逻辑回归模型调整混杂因素。
在 260 名 ART 和 314 名 SC 中，分别有 135 名和 152 名女性患有 GDM。与 SC 组相比，GDM 组（ART-GDM 和 SC-GDM）的母亲年龄更大，孕前 BMI 更高，妊娠时间更短，妊娠体重增加更少。与 SC 组相比，ART-GDM 组发生产科并发症的风险更高，包括 PIH [aOR：7.04（2.24-22.15）]、子痫前期 [aOR：7.78（1.62-37.47）]、APH [aOR：3.46（1.28-9.33）]、急诊 CS [aOR：2.64（1.43-4.88）]和围产儿结局，如 PTB [aOR：3.89（1.51-10.10）]、LBW [aOR：3.11（1.04-9.30）]和 NICU 入住 [aOR：4.36（1.82-10.45）]，以及新生儿低血糖 [aOR：4.91（1.50-16.07）]，而 SC 组的风险较低。与 SC 组相比，SC-GDM 组发生 PIH [aOR：4.12（1.31-12.89）]、急诊 CS [aOR：2.01（1.09-3.73]和 LGA [aOR：5.20（1.07-25.20）]的风险更高。此外，与 SC 组相比，ART 组发生 PIH [aOR：3.46（1.02-11.68）]、子痫前期 5.29（1.03-27.09）和 NICU 入住 [aOR：2.53（1.05-6.09）]的风险更高。与 SC-GDM 组相比，ART-GDM 组的胰岛素需求（41.8% vs. 25.7%）显著更高。
本研究结果表明，ART 受孕后发生的 GDM 增加了不良产科和围产儿结局的风险。
