Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
Am J Perinatol. 2021 Dec;38(14):1533-1539. doi: 10.1055/s-0040-1713887. Epub 2020 Jul 5.
The incidence of placenta accreta spectrum (PAS) has been increasing in the United States. In addition, there has also been an increase in the utilization of in vitro fertilization (IVF). The IVF pregnancies confer an increased risk of adverse obstetric and neonatal outcomes, but there is limited data on whether IVF is associated with PAS. The aim of this study is to assess the association between IVF and the risk of PAS.
This was a retrospective cohort study of deliveries from January 1, 2013 to August 1, 2018 at a tertiary hospital in the Massachusetts. IVF pregnancies were compared with non-IVF pregnancies, and PAS diagnosis was confirmed by histopathology reports. Hospital administrative data and medical record review were used, and supplemented with data from birth certificates from the Massachusetts Department of Public Health.
We identified 28,344 pregnancies that met inclusion criteria, of which 1,418 (5.0%) were IVF pregnancies. The overall incidence of PAS was 0.4% (2.2% in the IVF group and 0.3% in the non-IVF group). Women who underwent IVF had 5.5 times the risk of PAS (95% confidence interval [CI]: 3.4-8.7) compared with women in the non-IVF group, adjusted for maternal age, nulliparity, and year of delivery (Table 5). Compared with women in the non-IVF group, the IVF group had fewer prior cesarean deliveries (22.6 vs. 64.2%) and a lower prevalence of placenta previa (19.4 vs. 44.4%).
Women with an IVF pregnancy carry an increased risk of PAS compared with non-IVF. Among women who underwent IVF, there was a lower prevalence of prior cesarean deliveries and placenta previa. Future work is needed to identify the mechanism of association for this increased risk as well as a reliable tool for antenatal detection in this cohort of women.
· IVF pregnancies have higher risk of PAS than non-IVF pregnancies.. · IVF pregnancies with PAS do not exhibit common risk factors.. · IVF may be an independent risk factor for PAS..
胎盘植入谱系疾病（PAS）在美国的发病率一直在上升。此外，体外受精（IVF）的应用也在增加。IVF 妊娠会增加不良产科和新生儿结局的风险，但关于 IVF 是否与 PAS 相关的数据有限。本研究旨在评估 IVF 与 PAS 风险之间的关联。
这是一项回顾性队列研究，对象为 2013 年 1 月 1 日至 2018 年 8 月 1 日在马萨诸塞州一家三级医院分娩的孕妇。将 IVF 妊娠与非 IVF 妊娠进行比较，通过组织病理学报告确认 PAS 诊断。使用医院管理数据和病历回顾，并补充来自马萨诸塞州公共卫生部的出生证明数据。
我们确定了符合纳入标准的 28344 例妊娠，其中 1418 例（5.0%）为 IVF 妊娠。PAS 的总发生率为 0.4%（IVF 组为 2.2%，非 IVF 组为 0.3%）。与非 IVF 组相比，接受 IVF 的女性 PAS 风险增加 5.5 倍（95%置信区间[CI]：3.4-8.7），调整了产妇年龄、初产和分娩年份（表 5）。与非 IVF 组相比，IVF 组既往剖宫产次数较少（22.6%比 64.2%），胎盘前置的发生率较低（19.4%比 44.4%）。
与非 IVF 相比，IVF 妊娠的 PAS 风险增加。在接受 IVF 的女性中，既往剖宫产和胎盘前置的发生率较低。需要进一步研究以确定这种风险增加的关联机制以及在这部分女性中进行产前检测的可靠工具。
IVF 妊娠 PAS 风险高于非 IVF 妊娠。
患有 PAS 的 IVF 妊娠并不表现出常见的危险因素。
IVF 可能是 PAS 的独立危险因素。
