体外受精相关的严重产妇发病率风险：一项基于人群的研究。

Risk of severe maternal morbidity associated with in vitro fertilisation: a population-based study.

机构信息

Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.

Port Royal Maternity Unit, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, DHU Risks and Pregnancy, Paris Descartes University, Paris, France.

出版信息

BJOG. 2019 Jul;126(8):1033-1041. doi: 10.1111/1471-0528.15668. Epub 2019 Mar 27.

DOI:10.1111/1471-0528.15668

PMID:30801948

Abstract

OBJECTIVE

To investigate the association between in vitro fertilisation IVF and severe maternal morbidity (SMM) and to explore the role of multiple pregnancy as an intermediate factor.

DESIGN

Population-based cohort-nested case-control study.

SETTING

Six French regions in 2012/13.

POPULATION

Cases were 2540 women with SMM according to the EPIMOMS definition; controls were 3651 randomly selected women who gave birth without SMM.

METHODS

Analysis of the associations between IVF and SMM with multivariable logistic regression models, differentiating IVF with autologous oocytes (IVF-AO) from IVF with oocyte donation (IVF-OD). The contribution of multiple pregnancy as an intermediate factor was assessed by path analysis.

MAIN OUTCOME MEASURES

Severe maternal morbidity overall and SMM according to its main underlying causal condition and by severity (near misses).

RESULTS

The risk of SMM was significantly higher in women with IVF (adjusted OR = 2.5, 95% CI 1.8-3.3). The risk of SMM was significantly higher with IVF-AO, for all-cause SMM (aOR = 2.0, 95% CI 1.5-2.7), for near misses (aOR = 1.9, 95% CI 1.3-2.8), and for intra/postpartum haemorrhages (aOR = 2.3, 95% CI 1.6-3.2). The risk of SMM was significantly higher with IVF-OD, for all-cause SMM (aOR = 18.6, 95% CI 4.4-78.5), for near misses (aOR = 18.1, 95% CI 4.0-82.3), for SMM due to hypertensive disorders (aOR = 16.7, 95% CI 3.3-85.4) and due to intra/postpartum haemorrhages (aOR = 18.0, 95% CI 4.2-77.8). Path-analysis estimated that 21.6% (95% CI 10.1-33.0) of the risk associated with IVF-OD was mediated by multiple pregnancy, and 49.6% (95% CI 24.0-75.1) of the SMM risk associated with IVF-AO.

CONCLUSION

The risk of SMM is higher in IVF pregnancies after adjustment for confounders. Exploratory results suggest higher risks among women with IVF-OD; however, confidence intervals were wide, so this finding needs to be confirmed. A large part of the association between IVF-AO and SMM appears to be mediated by multiple pregnancy.

TWEETABLE ABSTRACT

The risk of severe maternal morbidity is higher in IVF-conceived pregnancies than in pregnancies conceived by other means.

摘要

目的

探讨体外受精（IVF）与严重孕产妇发病（SMM）的关联，并探讨多胎妊娠作为中介因素的作用。

设计

基于人群的队列嵌套病例对照研究。

地点

2012/13 年法国六个地区。

人群

病例为 2540 名根据 EPIMOMS 定义患有 SMM 的妇女；对照组为 3651 名随机选择的未发生 SMM 的分娩妇女。

方法

使用多变量逻辑回归模型分析 IVF 与 SMM 之间的关联，区分自体卵母细胞 IVF（IVF-AO）与卵母细胞捐赠 IVF（IVF-OD）。通过路径分析评估多胎妊娠作为中介因素的贡献。

主要观察指标

SMM 总体和根据其主要潜在因果条件以及严重程度（接近不良结局）的 SMM。

结果

与非 IVF 妊娠相比，IVF 妊娠发生 SMM 的风险显著更高（调整后的 OR=2.5，95%CI 1.8-3.3）。IVF-AO 在所有原因 SMM（aOR=2.0，95%CI 1.5-2.7）、接近不良结局（aOR=1.9，95%CI 1.3-2.8）和产后/产内出血（aOR=2.3，95%CI 1.6-3.2）方面的 SMM 风险更高。IVF-OD 在所有原因 SMM（aOR=18.6，95%CI 4.4-78.5）、接近不良结局（aOR=18.1，95%CI 4.0-82.3）、与高血压疾病相关的 SMM（aOR=16.7，95%CI 3.3-85.4）和产后/产内出血相关的 SMM（aOR=18.0，95%CI 4.2-77.8）方面的 SMM 风险更高。路径分析估计，IVF-OD 相关风险的 21.6%（95%CI 10.1-33.0）由多胎妊娠介导，IVF-AO 相关的 SMM 风险的 49.6%（95%CI 24.0-75.1）由多胎妊娠介导。