Zaat Tjitske R, Brink Anna J, de Bruin Jan-Peter, Goddijn Mariëtte, Broekmans Frank J M, Cohlen Ben J, Macklon Nick S, van Wely Madelon, Groenewoud Eva R, Mol Femke
Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9 Amsterdam, the Netherlands.
Department of Obstetrics and Gynecology, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 's-Hertogenbosch, the Netherlands.
Reprod Biomed Online. 2021 May;42(5):919-929. doi: 10.1016/j.rbmo.2021.01.015. Epub 2021 Feb 1.
What are the obstetric and neonatal risks for women conceiving via frozen-thawed embryo transfer (FET) during a modified natural cycle compared with an artificial cycle method.
A follow-up study to the ANTARCTICA randomized controlled trial (RCT) (NTR 1586) conducted in the Netherlands, which showed that modified natural cycle FET (NC-FET) was non-inferior to artificial cycle FET (AC-FET) in terms of live birth rates. The current study collected data on obstetric and neonatal outcomes of 98 women who had a singleton live birth. The main outcome was birthweight; additional outcomes included hypertensive disorder of pregnancy, premature birth, gestational diabetes, obstetric haemorrhage and neonatal outcomes including Apgar scores and admission to the neonatal ward or the neonatal intensive care unit and congenital anomalies.
Data from 82 out of 98 women were analysed according to the per protocol principle. There was no significant difference in the birthweights of children born between groups (mean difference -124 g [-363 g to 114 g]; P = 0.30). Women who conceived by modified NC-FET have a decreased risk of hypertensive disorders of pregnancy compared with AC-FET (relative risk 0.27; 95% CI 0.08-0.94; P = 0.031). Other outcomes, such as rates of premature birth, gestational diabetes or obstetric haemorrhage and neonatal outcomes, were not significantly different.
The interpretation is that modified NC-FET is the preferred treatment in women with ovulatory cycles undergoing FET when the increased risk of obstetrical complications and potential neonatal complications in AC-FET are considered.
与人工周期法相比，在改良自然周期中通过冻融胚胎移植（FET）受孕的女性的产科和新生儿风险有哪些？
这是一项对在荷兰进行的南极随机对照试验（RCT）（NTR 1586）的随访研究，该试验表明改良自然周期FET（NC-FET）在活产率方面不劣于人工周期FET（AC-FET）。本研究收集了98名单胎活产女性的产科和新生儿结局数据。主要结局是出生体重；其他结局包括妊娠高血压疾病、早产、妊娠期糖尿病、产科出血以及新生儿结局，如阿氏评分、入住新生儿病房或新生儿重症监护病房情况以及先天性异常。
根据符合方案原则对98名女性中的82名的数据进行了分析。两组间出生儿童的出生体重无显著差异（平均差值-124 g[-363 g至114 g]；P = 0.30）。与AC-FET相比，通过改良NC-FET受孕的女性患妊娠高血压疾病的风险降低（相对风险0.27；95%置信区间0.08 - 0.94；P = 0.031）。其他结局，如早产、妊娠期糖尿病或产科出血发生率以及新生儿结局，无显著差异。
解释是，当考虑到AC-FET中产科并发症和潜在新生儿并发症风险增加时，改良NC-FET是排卵周期女性进行FET的首选治疗方法。
