Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Assisted Reproduction, Shanghai Towako Hospital, Shanghai, China.
Hum Reprod. 2021 Jul 19;36(8):2111-2120. doi: 10.1093/humrep/deab088.
Does trophectoderm (TE) quality affect birthweight after single frozen-thawed blastocyst transfer?
Transfer of single blastocyst with advanced TE quality was associated with higher birthweight and increased risk of a large for gestational age (LGA) baby.
Transfer of blastocysts with advanced TE quality results in higher ongoing pregnancy rates and a lower miscarriage risk. However, data on the relationship between TE quality and birthweight are still lacking.
STUDY DESIGN, SIZE, DURATION: This retrospective cohort study at a tertiary-care academic medical center included 1548 singleton babies born from single frozen-thawed blastocyst transfer from January 2011 to June 2019.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Babies were grouped into four groups according to embryo expansion (Stages 3, 4, 5 and 6), three groups according to inner cell mass (ICM) quality (A, B and C), and three groups according to TE quality (A, B and C). Main outcomes included absolute birthweight, Z-scores adjusted for gestational age and gender, and adverse neonatal outcomes. Multivariable linear and logistic regression analyses were performed to investigate the association of neonatal outcomes with expansion stage, ICM quality and TE quality.
As TE quality decreased, birthweight (3468.10 ± 471.52, 3357.69 ± 522.06, and 3288.79 ± 501.90 for A, B and C, respectively, P = 0.002), Z-scores (0.59 ± 1.07, 0.42 ± 1.04, and 0.27 ± 1.06 for A, B and C, respectively, P = 0.002) and incidence of LGA (28.9%, 19.7% and 17.4% for A, B and C, respectively, P = 0.027) decreased correspondingly. After adjusting for confounders, compared with the Grade A group, blastocysts with TE Grade B (standardized coefficients (β): -127.97 g, 95% CI: -234.46 to -21.47, P = 0.019) and blastocysts with TE grade C (β: -200.27 g, 95% CI: -320.69 to -79.86, P = 0.001) resulted in offspring with lower birthweight. Blastocysts with TE grade C brought babies with lower Z-scores than TE Grade A (β: -0.35, 95% CI: -0.59 to -0.10, P = 0.005). Also, embryos with TE Grade B (adjusted odds ratio (aOR):0.91, 95% CI: 0.84 to 0.99, P = 0.033) and embryos with TE Grade C (aOR : 0.89, 95% CI: 0.81 to 0.98, P = 0.016) had lower chance of leading to a LGA baby than those with TE Grade A. No association between neonatal outcomes with embryo expansion stage and ICM was observed (all P > 0.05).
LIMITATIONS, REASONS FOR CAUTION: The retrospective design, lack of controlling for several unknown confounders, and inter-observer variation limited this study.
The study extends our knowledge of the down-stream effect of TE quality on newborn birthweight and the risk of LGA.
STUDY FUNDING/COMPETING INTEREST(S): This study was funded by National Key R&D Program of China (2018YFC1003000), National Natural Science Foundation of China (81771533 to Y.P.K. and 31200825 to L.S.) and Innovative Research Team of High-level Local Universities in Shanghai (SSMU-ZLCX20180401), Shanghai Sailing Program(21YF1423200) and the Fundamental research program funding of Ninth People's Hospital affiliated to Shanghai Jiao Tong university School of Medicine (JYZZ117). The authors declare no conflict of interest in this present study.
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滋养层（TE）质量是否会影响冻融后单个囊胚移植的出生体重？
转移具有高级 TE 质量的单个囊胚与较高的出生体重和较大的胎儿体重（LGA）婴儿的风险增加相关。
具有高级 TE 质量的囊胚移植会导致较高的持续妊娠率和较低的流产风险。然而，关于 TE 质量与出生体重之间关系的数据仍然缺乏。
研究设计、规模、持续时间：这是一项在上海交通大学医学院附属第九人民医院进行的回顾性队列研究，纳入了 2011 年 1 月至 2019 年 6 月期间，1548 例单冻融囊胚移植的单胎婴儿。
参与者/材料、地点、方法：根据胚胎扩张阶段（第 3、4、5 和 6 阶段）、内细胞团（ICM）质量（A、B 和 C）和滋养层质量（A、B 和 C）将婴儿分为四组和三组。主要结局包括绝对出生体重、按胎龄和性别调整的 Z 评分，以及不良新生儿结局。采用多变量线性和逻辑回归分析来研究新生儿结局与扩张阶段、ICM 质量和 TE 质量的关系。
随着 TE 质量的下降，出生体重（A、B 和 C 组分别为 3468.10±471.52、3357.69±522.06 和 3288.79±501.90，P=0.002）、Z 评分（A、B 和 C 组分别为 0.59±1.07、0.42±1.04 和 0.27±1.06，P=0.002）和 LGA 的发生率（A、B 和 C 组分别为 28.9%、19.7%和 17.4%，P=0.027）相应降低。调整混杂因素后，与 Grade A 组相比，TE Grade B（标准化系数（β）：-127.97g，95%CI：-234.46 至-21.47，P=0.019）和 TE Grade C（β：-200.27g，95%CI：-320.69 至-79.86，P=0.001）的囊胚导致新生儿体重较低。TE Grade C 的囊胚与 TE Grade A 的相比，Z 评分较低（β：-0.35，95%CI：-0.59 至-0.10，P=0.005）。此外，TE Grade B（调整后的优势比（aOR）：0.91，95%CI：0.84 至 0.99，P=0.033）和 TE Grade C（aOR：0.89，95%CI：0.81 至 0.98，P=0.016）的胚胎导致 LGA 婴儿的机会较低，而 Grade A 的胚胎则没有。
局限性、谨慎原因：回顾性设计、缺乏对几个未知混杂因素的控制以及观察者间的差异限制了这项研究。
该研究扩展了我们对 TE 质量对新生儿出生体重和 LGA 风险的下游影响的认识。
研究资金/利益冲突：本研究由国家重点研发计划（2018YFC1003000）、国家自然科学基金（81771533 至 Y.P.K.和 31200825 至 L.S.）和上海高水平地方高校创新团队计划（SSMU-ZLCX20180401）、上海扬帆计划（21YF1423200）和上海交通大学医学院附属第九人民医院基础研究项目资助（JYZZ117）。作者在本研究中没有利益冲突。
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