医学辅助生殖与早产风险：一项基于魁北克妊娠队列数据的病例对照研究。
Medically assisted reproduction and the risk of preterm birth: a case-control study using data from the Quebec Pregnancy Cohort.
机构信息
Research Centre (Gorgui, Sheehy, Bérard), Centre hospitalier universitaire Sainte-Justine; Faculty of Pharmacy (Gorgui, Bérard), University of Montréal; Departments of Pediatrics, Human Genetics and Pharmacology, and Therapeutics and Research Institute of the McGill University Health Centre (Trasler), McGill University, Montréal, Que.; Faculty of Medicine and Health Sciences (Fraser), University of Sherbrooke, Sherbrooke, Que.
出版信息
CMAJ Open. 2020 Mar 19;8(1):E206-E213. doi: 10.9778/cmajo.20190082. Print 2020 Jan-Mar.
BACKGROUND
The use of fertility treatments has been growing over the past decade, but these treatments are not without risk. We aimed to quantify the risk of preterm birth associated with the use of ovarian stimulators (OS) and assisted reproductive technologies (ART) overall and by type of fertility treatment.
METHODS
We conducted a case-control analysis of data from the Quebec Pregnancy Cohort. We included singleton pregnancies ending in a live birth during the time when Quebec operated a universal reimbursement program for assisted reproduction (2010-2015). Fertility treatments were defined dichotomously, and pregnancies resulting from spontaneous conception were used as the reference. We categorized fertility treatments into subgroups: ovarian stimulators alone, ART alone and OS and ART combined. Preterm birth was defined as birth before 37 weeks' gestation. We estimated odds ratios (ORs) for the association between type of assisted reproduction and preterm birth using generalized estimating equation models and adjusted ORs for potential confounders.
RESULTS
A total of 57 624 pregnancies were included in the study. During the study period, 2055 pregnancies were conceived through the use of OS, ART or both: 419 involved OS alone, 150 involved ART alone and 1486 involved both OS and ART. When we adjusted for potential confounders, conception with OS, ART or both was associated with an increased risk of preterm birth (adjusted OR 1.46, 95% confidence interval [CI] 1.25-1.72, 182 exposed cases). All types of assisted reproduction were associated with an increased risk of preterm birth compared with pregnancies conceived spontaneously (OS alone: adjusted OR 1.47, 95% CI 1.04-2.07; ART alone: adjusted OR 1.76, 95% CI 1.01-3.06; OS and ART combined: adjusted OR 1.43, 95% CI 1.19-1.73). Use of OS or ART or both was associated with an increased risk of late, moderate and extremely preterm birth (extremely preterm birth: adjusted OR 2.39, 95% CI 1.30-4.39).
INTERPRETATION
Compared with pregnancies conceived spontaneously, pregnancies conceived through the use of OS, ART or both were associated with a 46% increased risk of preterm birth. Physicians should advise patients of the increased risks of late, moderate and extremely preterm birth so that they can make informed choices.
背景
在过去的十年中，生育治疗的使用一直在增长，但这些治疗并非没有风险。我们旨在量化使用卵巢刺激物（OS）和辅助生殖技术（ART）总体以及按生育治疗类型与早产相关的风险。
方法
我们对魁北克妊娠队列的数据进行了病例对照分析。我们纳入了在魁北克实行辅助生殖普遍报销计划期间（2010-2015 年）以活产结束的单胎妊娠。生育治疗被定义为二分类，自发妊娠的妊娠作为参考。我们将生育治疗分为亚组：单独使用卵巢刺激物、单独使用 ART 以及 OS 和 ART 联合使用。早产定义为妊娠 37 周前分娩。我们使用广义估计方程模型估计与辅助生殖类型相关的早产关联的优势比（OR），并调整潜在混杂因素的调整 OR。
结果
共有 57624 例妊娠纳入研究。在研究期间，2055 例妊娠通过使用 OS、ART 或两者结合受孕：419 例涉及单独使用 OS，150 例涉及单独使用 ART，1486 例涉及 OS 和 ART 联合使用。当我们调整潜在混杂因素时，使用 OS、ART 或两者结合受孕与早产风险增加相关（调整后的 OR 1.46，95%置信区间[CI]1.25-1.72，182 例暴露病例）。与自然受孕的妊娠相比，所有类型的辅助生殖都与早产风险增加相关（单独使用 OS：调整后的 OR 1.47，95%CI 1.04-2.07；单独使用 ART：调整后的 OR 1.76，95%CI 1.01-3.06；OS 和 ART 联合使用：调整后的 OR 1.43，95%CI 1.19-1.73）。使用 OS 或 ART 或两者与晚期、中度和极早产风险增加相关（极早产：调整后的 OR 2.39，95%CI 1.30-4.39）。
解释
与自然受孕的妊娠相比，通过使用 OS、ART 或两者结合受孕的妊娠与早产风险增加 46%相关。医生应告知患者晚期、中度和极早产的风险增加，以便他们能够做出明智的选择。
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