不孕症治疗与严重产妇发病率的风险：倾向评分匹配队列研究。
Infertility treatment and risk of severe maternal morbidity: a propensity score-matched cohort study.
机构信息
Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont.
出版信息
CMAJ. 2019 Feb 4;191(5):E118-E127. doi: 10.1503/cmaj.181124.
BACKGROUND
The extent to which infertility treatment predicts severe maternal morbidity is not well known. We examined the association between infertility treatment and severe maternal morbidity in pregnancy and the postpartum period.
METHODS
We conducted a cohort study using population-based registries from Ontario between 2006 and 2012. Pregnancies achieved using infertility treatment (ovulation induction, intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection) were compared with unassisted pregnancies using propensity score matching, based on demographic, reproductive and obstetric factors. The primary outcome was a validated composite of severe maternal morbidity or maternal death from 20 weeks' gestation to 42 days postpartum. We also calculated the odds ratio of a woman having 1, 2, or 3 or more severe maternal morbidity indicators in relation to invasive (e.g., in vitro fertilization) or noninvasive (e.g., intrauterine insemination) infertility treatment.
RESULTS
We matched 11 546 infertility treatment pregnancies with 47 553 untreated pregnancies. Severe maternal morbidity or maternal death occurred in 356 infertility-treated pregnancies (30.8 per 1000 deliveries) versus 1054 untreated pregnancies (22.2 per 1000 deliveries); relative risk 1.39 (95% confidence interval [CI] 1.23-1.56). The likelihood of a woman having 3 or more severe maternal morbidity indicators was increased in women who received invasive infertility treatment (odds ratio [OR] 2.28, 95% CI 1.56-3.33) but not in those who received noninvasive infertility treatment (OR 0.99, 95% CI 0.57-1.72).
INTERPRETATION
Women who undergo infertility treatment, particularly in vitro fertilization, are at somewhat higher risk of severe maternal morbidity or death. Efforts are needed to identify patient- and treatment-specific predictors of severe maternal morbidity that may influence the type of treatment a woman is offered.
背景
不孕治疗与妊娠及产后严重产妇发病率之间的关联程度尚不清楚。我们研究了不孕治疗与妊娠及产后严重产妇发病率之间的关系。
方法
我们利用 2006 年至 2012 年安大略省基于人群的注册数据进行了一项队列研究。通过基于人口统计学、生殖和产科因素的倾向评分匹配，将使用不孕治疗（诱导排卵、宫腔内人工授精或体外受精加或不加胞浆内精子注射）获得的妊娠与未辅助妊娠进行比较。主要结局是从妊娠 20 周至产后 42 天发生的严重产妇发病率或产妇死亡的验证性复合结局。我们还计算了与侵袭性（如体外受精）或非侵袭性（如宫腔内人工授精）不孕治疗相关的患有 1、2 或 3 个或更多严重产妇发病率指标的妇女的比值比。
结果
我们将 11546 例不孕治疗妊娠与 47553 例未治疗妊娠进行了匹配。在 356 例接受不孕治疗的妊娠中（每 1000 例分娩中有 30.8 例）发生了严重产妇发病率或产妇死亡，在 1054 例未接受治疗的妊娠中（每 1000 例分娩中有 22.2 例）；相对风险 1.39（95%置信区间 [CI] 1.23-1.56）。接受侵袭性不孕治疗的妇女发生 3 个或更多严重产妇发病率指标的可能性增加（比值比 [OR] 2.28，95%CI 1.56-3.33），但接受非侵袭性不孕治疗的妇女则没有（OR 0.99，95%CI 0.57-1.72）。
解释
接受不孕治疗，尤其是体外受精的妇女，发生严重产妇发病率或死亡的风险略高。需要努力确定可能影响妇女所接受治疗类型的严重产妇发病率的患者和治疗特定预测因素。
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