Department of Obstetrics-Gynecology, University of Massachusetts Medical School-Baystate, Springfield, MA.
Department of Obstetrics-Gynecology, University of Massachusetts Medical School-Baystate, Springfield, MA.
Am J Obstet Gynecol. 2021 Sep;225(3):285.e1-285.e7. doi: 10.1016/j.ajog.2021.04.235. Epub 2021 Apr 21.
Contemporary embryo biopsy in the United States involves the removal of several cells from a blastocyst that would become the placenta for preimplantation genetic testing. Embryos are then cryopreserved while patients await biopsy results, with transfers occurring in a subsequent cycle as a single frozen-thawed embryo transfer, if euploid.
We sought to determine if removal of these cells for preimplantation genetic testing was associated with adverse obstetrical or neonatal outcomes after frozen-thawed single embryo transfer.
We linked assisted reproductive technology surveillance data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System to birth certificates and maternal and neonatal hospitalization discharge diagnoses in Massachusetts from 2014 to 2017, considering only singleton births after frozen-thawed single embryo transfers. We compared outcomes of cycles having embryo biopsy (n=585) to those having no biopsy (n=2191) using chi-square for categorical and binary variables and logistic regression for adjusted odds ratios and 95% confidence intervals, adjusting for mother's age, race, education, parity, body mass index, birth year, insurance, and all infertility diagnoses.
Considering no biopsy as the reference, there was no difference between groups with respect to preeclampsia (adjusted odds ratio, 0.82; 95% confidence interval, 0.42-1.61; P=.5685); pregnancy-induced hypertension (adjusted odds ratio, 0.85; 95% confidence interval, 0.46-1.59; P=.6146); placental disorders, including placental abruption, placenta previa, placenta accreta, placenta increta, and placenta percreta (adjusted odds ratio, 1.16; 95% confidence interval, 0.60-2.24; P=.6675); preterm birth (adjusted odds ratio, 1.22; 95% confidence interval 0.73-2.03; P=.4418); low birthweight (adjusted odds ratio, 1.12; 95% confidence interval, 0.58-2.15; P=.7355); cesarean delivery (adjusted odds ratio, 1.04; 95% confidence interval, 0.79-1.38; P=.7762); or gestational diabetes mellitus (adjusted odds ratio, 0.83; 95% confidence interval, 0.50-1.38; P=.4734). In addition, there was no difference between the groups for prolonged hospital stay for mothers (adjusted odds ratio, 1.23; 95% confidence interval, 0.83-1.80; P=.3014) or for infants (95% confidence interval, 1.29; 95% confidence interval, 0.72-2.29; P=.3923).
Embryo biopsy for preimplantation genetic testing does not increase the odds for diagnoses related to placentation (preeclampsia, pregnancy-related hypertension, placental disorders, preterm delivery, or low birthweight), maternal conditions (gestational diabetes mellitus), or maternal or infant length of stay after delivery.
在美国，当代胚胎活检涉及从滋养外胚层中取出几个细胞，这些细胞将成为胚胎着床前遗传学检测的胎盘。然后，胚胎被冷冻保存，同时患者等待活检结果，如果是整倍体，则在随后的周期中进行单次冻融胚胎移植。
我们旨在确定在冷冻解冻后的单胚胎移植后，是否因进行胚胎着床前遗传学检测而导致不良的产科或新生儿结局。
我们将辅助生殖技术监测数据与马萨诸塞州的生育登记处和产妇及新生儿住院诊断记录进行了链接，这些数据来自于 2014 年至 2017 年期间的辅助生殖技术协会诊所结果报告系统，仅考虑冷冻解冻后的单胚胎移植后的单胎妊娠。我们使用卡方检验比较了有活检组（n=585）和无活检组（n=2191）的结局，对于分类变量和二项变量使用逻辑回归进行了调整，对于调整后的优势比和 95%置信区间，我们调整了母亲的年龄、种族、教育程度、产次、体重指数、出生年份、保险和所有不孕诊断。
在无活检的情况下，与对照组相比，两组之间的子痫前期（调整后的优势比，0.82；95%置信区间，0.42-1.61；P=.5685）；妊娠高血压（调整后的优势比，0.85；95%置信区间，0.46-1.59；P=.6146）；胎盘疾病，包括胎盘早剥、前置胎盘、胎盘植入、胎盘植入和胎盘穿透（调整后的优势比，1.16；95%置信区间，0.60-2.24；P=.6675）；早产（调整后的优势比，1.22；95%置信区间，0.73-2.03；P=.4418）；低出生体重儿（调整后的优势比，1.12；95%置信区间，0.58-2.15；P=.7355）；剖宫产分娩（调整后的优势比，1.04；95%置信区间，0.79-1.38；P=.7762）；或妊娠期糖尿病（调整后的优势比，0.83；95%置信区间，0.50-1.38；P=.4734）无差异。此外，两组母亲（调整后的优势比，1.23；95%置信区间，0.83-1.80；P=.3014）或婴儿（95%置信区间，1.29；95%置信区间，0.72-2.29；P=.3923）的住院时间无差异。
胚胎着床前遗传学检测的胚胎活检并不会增加与胎盘相关的诊断（子痫前期、妊娠相关高血压、胎盘疾病、早产或低出生体重）、产妇情况（妊娠期糖尿病）或产妇和婴儿分娩后住院时间的发生几率。
