Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3° piso, CEP: 96020-220, Bairro Centro, Pelotas, Rio Grande do Sul, Brazil.
Medical school, Federal University of Fronteira Sul - Campus Passo Fundo, RS. Rua Cap. Araújo, 20 - Passo Fundo, Pelotas, Rio Grande do Sul, 99010-121, Brazil.
BMC Pregnancy Childbirth. 2020 Feb 21;20(1):106. doi: 10.1186/s12884-020-2755-z.
Studies comparing the outcome of spontaneous versus assisted reproductive technologies (ART) pregnancies report heterogeneous results. Despite the success of ART to overcome infertility, concern is growing regarding both its safety and its effect on maternal and child health. The objective of this study was to compare maternal and child-health outcomes after ART relative to natural conception.
A population-based birth cohort study was carried out among pregnant women expected to deliver in 2015 in Pelotas, southern Brazil. Maternal outcomes included pregnancy complications and gestational weight gain. Gestational age, weight, intrauterine growth restriction, length and head circumference, and 1-min and 5-min Apgar, as well as health problems at birth and breastfeeding were defined as offspring outcomes. Statistical analyses were performed using linear and logistic regression. G-formula was used to perform mediation analysis.
The study included 4252 babies born by spontaneously pregnancies and 23 babies born after ART. Adjusted analyses showed that children conceived from ART presented lower means of gestational age (p = 0.001), birth weight (p = 0.002), length (p < 0.001), and head circumference at birth (p = 0.02). However, more than 90% of the effect of ART over these outcomes was mediated by multiple pregnancy.
Our findings suggest that the possible negative effect on the child-health outcomes is due mainly to the higher incidence of multiple pregnancies and not because of ART. The reasons for the increase in adverse pregnancy outcomes associated with ART singleton pregnancies are still uncertain and warrants further research. Further large-population studies are needed to confirm these results.
比较自然妊娠和辅助生殖技术（ART）妊娠结局的研究报告结果存在差异。尽管 ART 成功地克服了不孕不育，但人们对其安全性及其对母婴健康的影响的担忧日益增加。本研究的目的是比较 ART 后与自然受孕的母婴健康结局。
这是一项在巴西南部佩洛塔斯进行的基于人群的妊娠队列研究，研究对象为预计于 2015 年分娩的孕妇。母亲的结局包括妊娠并发症和妊娠体重增加。胎龄、体重、宫内生长受限、长度和头围、1 分钟和 5 分钟 Apgar 评分以及出生时和母乳喂养的健康问题被定义为后代结局。使用线性和逻辑回归进行统计分析。使用 G 公式进行中介分析。
该研究纳入了 4252 名自然妊娠分娩的婴儿和 23 名接受 ART 妊娠的婴儿。调整分析显示，通过 ART 受孕的儿童胎龄（p=0.001）、出生体重（p=0.002）、长度（p<0.001）和头围（p=0.02）的平均值较低。然而，ART 对这些结果的影响超过 90%是通过多胎妊娠来介导的。
我们的研究结果表明，对儿童健康结局的可能负面影响主要是由于多胎妊娠的发生率较高，而不是因为 ART。ART 单胎妊娠与不良妊娠结局增加的原因仍不确定，需要进一步研究。需要进一步进行大型人群研究来证实这些结果。
