Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Victory 4 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada.
Health Technology Assessment Program, Oswaldo Cruz Foundation, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ, 21040-900, Brazil.
BMC Pregnancy Childbirth. 2021 Jun 28;21(1):449. doi: 10.1186/s12884-021-03938-8.
Hypertensive disorders of pregnancy (HDP) is one of the most common pregnancy complications and causes of maternal morbidity and mortality. Assisted reproductive technology (ART) has been associated with adverse pregnancy outcomes, including HDP. However, the impact of multiple pregnancies, oocyte donation, as well as fresh and frozen embryo transfer needs to be further studied. We conducted a systematic review and meta-analyses to evaluate the association between ART and HDP or preeclampsia relative to spontaneous conception (SC).
We identified studies from EMBASE, MEDLINE, and Cochrane Library (up to April 8, 2020) and manually using structured search strategies. Cohort studies that included pregnancies after in vitro fertilization (IVF) with or without intracytoplasmic sperm fertilization (ICSI) relative to SC with HDP or preeclampsia as the outcome of interest were included. The control group was women who conceived spontaneously without ART or fertility medications. The pooled results were reported in odds ratios (OR) with 95% confidence intervals based on random effects models. Numbers needed to harm (NNH) were calculated based on absolute risk differences between exposure and control groups.
Eighty-five studies were included after a screening of 1879 abstracts and 283 full text articles. Compared to SC, IVF/ICSI singleton pregnancies (OR 1.70; 95% CI 1.60-1.80; I = 80%) and multiple pregnancies (OR 1.34; 95% CI 1.20-1.50; I = 76%) were both associated with higher odds of HDP. Singleton pregnancies with oocyte donation had the highest odds of HDP out of all groups analyzed (OR 4.42; 95% CI 3.00-6.51; I = 83%). Frozen embryo transfer resulted in higher odds of HDP (OR 1.74; 95% CI 1.58-1.92; I = 55%) than fresh embryo transfer (OR 1.43; 95% CI 1.33-1.53; I = 72%). The associations between IVF/ICSI pregnancies and SC were similar for preeclampsia. Most interventions had an NNH of 40 to 100, while singleton and multiple oocyte donation pregnancies had particularly low NNH for HDP (16 and 10, respectively).
Our meta-analysis confirmed that IVF/ICSI pregnancies are at higher odds of HDP and preeclampsia than SC, irrespective of the plurality. The odds were especially high in frozen embryo transfer and oocyte donation pregnancies.
妊娠高血压疾病（HDP）是最常见的妊娠并发症之一，也是孕产妇发病率和死亡率升高的主要原因。辅助生殖技术（ART）与不良妊娠结局相关，包括 HDP。然而，多胎妊娠、卵母细胞捐赠以及新鲜和冷冻胚胎移植的影响仍需要进一步研究。我们进行了系统回顾和荟萃分析，以评估相对于自然受孕（SC），ART 与 HDP 或子痫前期之间的关联。
我们从 EMBASE、MEDLINE 和 Cochrane Library（截至 2020 年 4 月 8 日）中检索研究，并使用结构化搜索策略进行人工检索。纳入了包含体外受精（IVF）后妊娠的队列研究，无论是否进行了胞浆内精子注射（ICSI），并将 HDP 或子痫前期作为感兴趣的结局，对照组为未经 ART 或生育药物治疗而自然受孕的女性。基于随机效应模型，以比值比（OR）和 95%置信区间报告汇总结果。基于暴露组和对照组之间的绝对风险差异计算需要治疗的人数（NNH）。
在筛选了 1879 篇摘要和 283 篇全文文章后，共纳入了 85 项研究。与 SC 相比，IVF/ICSI 单胎妊娠（OR 1.70；95%CI 1.60-1.80；I=80%）和多胎妊娠（OR 1.34；95%CI 1.20-1.50；I=76%）均与 HDP 的发生几率增加相关。在所有分析的组中，卵母细胞捐赠的单胎妊娠发生 HDP 的几率最高（OR 4.42；95%CI 3.00-6.51；I=83%）。与新鲜胚胎移植（OR 1.43；95%CI 1.33-1.53；I=72%）相比，冷冻胚胎移植（OR 1.74；95%CI 1.58-1.92；I=55%）导致 HDP 的几率更高。IVF/ICSI 妊娠与 SC 之间与子痫前期的关联相似。大多数干预措施的 NNH 为 40 至 100，而单胎和多胎卵母细胞捐赠妊娠的 HDP NNH 特别低（分别为 16 和 10）。
我们的荟萃分析证实，与 SC 相比，IVF/ICSI 妊娠发生 HDP 和子痫前期的几率更高，而与多胎妊娠无关。冷冻胚胎移植和卵母细胞捐赠妊娠的几率尤其高。
