Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Pediatrics, West China Second University Hospital, Sichuan University, 20 South Renmin Road 3rd Section, Wuhou District, Chengdu 610041, China.
World J Pediatr. 2021 Aug;17(4):364-374. doi: 10.1007/s12519-021-00442-z. Epub 2021 Jul 20.
Several studies have assessed the association between cerebral palsy (CP) and assisted reproductive technology (ART), but the results remain controversial. We conducted a meta-analysis to evaluate the risk of CP after ART compared with natural conceptions and to examine CP risk separately in ART singletons, multiples and preterm births.
Web-based databases (PubMed, Embase, the Cochrane Library, and Web of Science) were searched until November 22, 2020. Studies which compare CP rates after ART with natural conceptions were included. The Newcastle-Ottawa Scale was used to assess the quality of the included studies. Effect estimates were extracted and combined using the fixed-effects or random-effects model depending on the heterogeneity test.
There were nine studies included in the meta-analysis. The included studies were of moderate or high quality. A significantly higher risk of CP [odds ratio (OR) = 2.17, 95% confidence interval (CI) 1.72-2.74] was found in ART children (n = 89,214) compared with naturally conceived children (n = 4,160,745). The significantly higher risk decreased when data were restricted to singletons (OR = 1.36, 95% CI 1.16-1.59) and disappeared when data were restricted to multiples (OR = 1.05, 95% CI 0.86-1.29) or preterm births (OR = 1.53, 95% CI 0.66-3.56). Subgroup and sensitivity analyses indicated that the overall results were robust.
The risk of CP is increased more than two-fold after ART. This increased risk is largely due to increased rates of multiple birth and preterm delivery in ART children.
已有多项研究评估了脑瘫（CP）与辅助生殖技术（ART）之间的关联，但结果仍存在争议。我们进行了一项荟萃分析，以评估与自然受孕相比，ART 后 CP 的风险，并分别检查 ART 单胎、多胎和早产儿的 CP 风险。
我们在网上数据库（PubMed、Embase、Cochrane 图书馆和 Web of Science）进行了检索，检索时间截至 2020 年 11 月 22 日。纳入了比较 ART 后 CP 发生率与自然受孕的研究。使用纽卡斯尔-渥太华量表评估纳入研究的质量。根据异质性检验，采用固定效应或随机效应模型提取和合并效应估计值。
共有 9 项研究纳入荟萃分析。纳入研究的质量为中高度。与自然受孕的儿童（n=4160745）相比，ART 儿童（n=89214）CP 的风险显著更高[比值比（OR）=2.17，95%置信区间（CI）1.72-2.74]。当数据仅限于单胎时，风险显著降低（OR=1.36，95% CI 1.16-1.59），当数据仅限于多胎（OR=1.05，95% CI 0.86-1.29）或早产儿（OR=1.53，95% CI 0.66-3.56）时，风险消失。亚组和敏感性分析表明，总体结果是稳健的。
ART 后 CP 的风险增加了两倍多。这种风险增加主要归因于 ART 儿童多胎和早产的发生率增加。
