Vannuccini Silvia, Ferrata Chiara, Perelli Federica, Pinzauti Serena, Severi Filiberto M, Reis Fernando M, Petraglia Felice, Di Tommaso Mariarosaria
Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, 'S. Maria alle Scotte' University Hospital, viale Bracci, Siena, Italy.
Department of Health Sciences, University of Florence, Careggi University Hospital, Largo Brambilla, Florence, Italy.
Hum Reprod Open. 2018 Jul 24;2018(3):hoy012. doi: 10.1093/hropen/hoy012. eCollection 2018.
Do singleton uncomplicated term pregnancies conceived by assisted reproductive technology (ART) have adverse peripartum and postpartum outcomes?
Term pregnancies following ART, even if uncomplicated until birth, have a higher risk of retained placenta and postpartum hemorrhage (PPH).
There is consistent evidence that pregnancies following ART have higher incidence of complications during pregnancy. However, few studies specifically investigated birth outcomes in ART term pregnancies.
A retrospective cohort study was conducted on 14 415 deliveries at two university tertiary care obstetric units. Clinical data were extracted by reviewing obstetric records of all deliveries from 1 January 2010 to 31 December 2014, in a standardized electronic database regarding the mother's health before and during pregnancy, complications during pregnancy and at birth, and neonatal outcome.
PARTICIPANTS/MATERIALS SETTING METHODS: Following an accurate evaluation of exclusion criteria (multiparity, maternal pre-pregnancy diseases, prior uterine surgery, fetal malformations, intrauterine deaths, elective cesarean section and pregnancy complications), the group of uncomplicated singleton term pregnancies from autologous ART conception by fertilization (IVF) or intracytoplasmic sperm injection (ICSI) ( = 188) was compared with a maternal age and body mass index (BMI) matched group of spontaneous pregnancies ( = 1168). Cases of intrauterine insemination (IUI) ( = 14) and ovulation induction with timed intercourse ( = 18) were not included. Labor, delivery and postpartum outcomes were evaluated. Odds ratios (OR) were adjusted with multivariable logistic regression to maternal age, BMI, nationality and gestational age at birth.
The age of women in the final analysis ranged from 25 to 45 years, while BMI ranged from 17 to 34 kg/m. Uncomplicated term pregnancies with ART conception had a higher risk of operative delivery (adjusted OR 1.40, 95% confidence interval (CI) 1.01-1.95), retained placenta (adjusted OR 2.63, 95% CI 1.31-5.26) and PPH (adjusted OR 2.86 95% CI 1.37-5.99). Conversely, ART conception did not increase the risk of induced labor (adjusted OR 1.18, 95% CI 0.85-1.65). However, patients that conceived by ART and underwent labor induction had a higher risk of failed induction compared with the control group (adjusted OR 2.53, 95% CI 1.23-5.21). Infants born after ART had a similar birthweight, Apgar score and arterial blood pH compared with spontaneously-conceived ones.
The database lacked specific information about causes of infertility, smoking habit, family income and details on ART (fresh versus frozen cycle, IVF versus ICSI), limiting, in part, our analysis of the results. However, only autologous IVF/ICSI pregnancies were included in order to prevent bias related to conception by oocyte/embryo donation. conception ART cases were excluded because they were too few to allow comparison with IVF/ICSI. Nevertheless, the inclusion of only uncomplicated pregnancies provides a highly homogeneous and still representative population sample. Study sample is representative of a well-resourced obstetric facility in a high-income country, limiting to some extent the generalizability of study results.
Pregnancies conceived by autologous ART that proceed uncomplicated until term may require counseling about the risk of placental retention with PPH.
STUDY FUNDING/COMPETING INTERESTS: The authors have no conflict of interest and funding to declare.
通过辅助生殖技术（ART）受孕的单胎无并发症足月妊娠是否有不良的围产期和产后结局？
ART后的足月妊娠，即使在出生前无并发症，发生胎盘滞留和产后出血（PPH）的风险也更高。
有一致的证据表明，ART后的妊娠在孕期并发症发生率更高。然而，很少有研究专门调查ART足月妊娠的分娩结局。
在两个大学三级护理产科单位对14415例分娩进行了一项回顾性队列研究。通过查阅2010年1月1日至2014年12月31日所有分娩的产科记录，从一个标准化电子数据库中提取临床数据，该数据库涉及母亲孕前和孕期的健康状况、孕期和分娩时的并发症以及新生儿结局。
参与者/材料设置方法：在准确评估排除标准（多胎妊娠、母亲孕前疾病、既往子宫手术、胎儿畸形、宫内死亡、择期剖宫产和妊娠并发症）后，将通过体外受精（IVF）或卵胞浆内单精子注射（ICSI）进行自体ART受孕的无并发症单胎足月妊娠组（n = 188）与年龄和体重指数（BMI）匹配的自然妊娠组（n = 1168）进行比较。不包括宫内人工授精（IUI）病例（n = 14）和定时性交诱导排卵病例（n = 18）。评估分娩、产后结局。通过多变量逻辑回归对出生时的母亲年龄、BMI、国籍和孕周进行比值比（OR）调整。
最终分析中的女性年龄范围为25至45岁，BMI范围为17至34 kg/m²。ART受孕的无并发症足月妊娠进行手术分娩的风险更高（调整后的OR 1.40，95%置信区间（CI）1.01 - 1.95）、胎盘滞留风险更高（调整后的OR 2.63，95% CI 1.31 - 5.26）以及PPH风险更高（调整后的OR 2.86，95% CI 1.37 - 5.99）。相反，ART受孕并未增加引产风险（调整后的OR 1.18，95% CI 0.85 - 1.65）。然而，与对照组相比，通过ART受孕并接受引产的患者引产失败风险更高（调整后的OR 2.53，95% CI 1.23 - 5.21）。与自然受孕的婴儿相比，ART后出生的婴儿出生体重、阿氏评分和动脉血pH值相似。
该数据库缺乏关于不孕原因、吸烟习惯、家庭收入以及ART细节（新鲜周期与冷冻周期、IVF与ICSI）的具体信息，部分限制了我们对结果的分析。然而，仅纳入自体IVF/ICSI妊娠以防止与卵母细胞/胚胎捐赠受孕相关的偏倚。排除了IUI受孕ART病例，因为数量太少无法与IVF/ICSI进行比较。尽管如此，仅纳入无并发症妊娠提供了一个高度同质且仍具代表性的人群样本。研究样本代表了高收入国家资源丰富的产科机构，在一定程度上限制了研究结果的可推广性。
通过自体ART受孕且直至足月无并发症的妊娠可能需要就胎盘滞留伴PPH的风险进行咨询。
研究资金/利益冲突：作者声明无利益冲突及资金来源。
