Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Baystate, 759 Chestnut Street, S1683, Springfield, MA, 01199, USA.
Department of Epidemiology and Biostatistics, Baystate Medical Center, Springfield, MA, USA.
Reprod Biol Endocrinol. 2020 Jul 11;18(1):68. doi: 10.1186/s12958-020-00627-7.
Multiple births and first pregnancy are associated with higher preeclampsia risk. It is unknown if the transfer of multiple embryos or first embryo transfer with assisted reproductive technology (ART) is also associated with greater preeclampsia risk.
We performed a retrospective cohort study of IVF clinics and hospitals in Massachusetts. We used linked ART surveillance, birth certificate, and maternal hospitalization discharge data for 21,188 births, considering resident singleton (12,810) and twin (8378) live-births from autologous or donor eggs from 2005 to 2012. We used log binomial and Poisson regression to calculate adjusted relative risks (aRRs) and 95% confidence intervals (CI) for the association between preeclampsia and predictors of preeclampsia. Outcomes were stratified by singleton and twin birth, donor versus autologous cycles, and use of fresh versus cryopreserved embryos.
Considering all singleton births, the transfer of multiple embryos increased the risk of preeclampsia [aRR = 1.10 (95% CI: 1.01-1.19)]. Relative risks were greatest for fresh non-donor cycles [aRR = 1.14 (95% CI: 1.03-1.26)]. Vanishing twin and number of prior ART cycles was not associated with preeclampsia among singleton births [aRR = 1.18 (95% CI: 0.91-1.53)], and aRR = 1.01 (95% CI: 0.96-1.05)], respectively. Considering all twin births, the transfer of > 2 embryos increased the risk of preeclampsia [aRR = 1.09 (95% CI: 1.001-1.19)]. Vanishing triplet and number of prior ART cycles were not associated with preeclampsia among twin births [aRR = 0.93 (95% CI: 0.69-1264), and aRR = 0.98 (CI: 0.95-1.02)], respectively.
Among ART births, the transfer of more than 1 embryo for singleton gestations and more than 2 embryos for twin gestations increased the risk for preeclampsia diagnosis.
多胎妊娠和首次妊娠与子痫前期风险增加相关。目前尚不清楚是否移植多个胚胎或首次胚胎移植时使用辅助生殖技术（ART）也与更高的子痫前期风险相关。
我们对马萨诸塞州的 IVF 诊所和医院进行了回顾性队列研究。我们使用了 ART 监测、出生证明和产妇住院出院数据，共纳入了 21188 例活产儿，包括 2005 年至 2012 年期间来自自体或供体卵子的居民单胎（12810 例）和双胎（8378 例）。我们使用对数二项式和泊松回归计算了子痫前期与子痫前期预测因素之间的关联的调整后相对风险（aRR）和 95%置信区间（CI）。结局按单胎和双胎分娩、供卵与自体周期以及新鲜胚胎与冷冻胚胎的使用进行分层。
考虑所有单胎分娩，移植多个胚胎会增加子痫前期的风险[aRR=1.10（95%CI：1.01-1.19）]。对于新鲜的非供卵周期，相对风险最大[aRR=1.14（95%CI：1.03-1.26）]。单胎分娩时，消失的双胞胎和之前的 ART 周期数与子痫前期无关[aRR=1.18（95%CI：0.91-1.53）]和[aRR=1.01（95%CI：0.96-1.05）]。对于所有双胎分娩，移植>2 个胚胎会增加子痫前期的风险[aRR=1.09（95%CI：1.001-1.19）]。双胎分娩时，消失的三胞胎和之前的 ART 周期数与子痫前期无关[aRR=0.93（95%CI：0.69-1264）]和[aRR=0.98（95%CI：0.95-1.02）]。
在 ART 分娩中，对于单胎妊娠，移植超过 1 个胚胎，对于双胎妊娠，移植超过 2 个胚胎会增加子痫前期的诊断风险。
