Richardson Hayley, Kalliora Charikleia, Mainigi Monica, Coutifaris Christos, Sammel Mary D, Senapati Suneeta
Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
F S Rep. 2021 Dec 31;3(1):13-19. doi: 10.1016/j.xfre.2021.12.006. eCollection 2022 Mar.
To assess whether the mode of conception and embryo biopsy impact first-trimester human chorionic gonadotropin (hCG) dynamics and subsequent risk of small for gestational age (SGA) or large for gestational age (LGA).
Retrospective cohort study.
University fertility center.
Six hundred-two pregnant patients with singleton live births.
Serial serum hCG measurements were obtained between 10 and 28 days postconception to determine the within-woman rate of change in hCG (slope) by mode of conception (unassisted pregnancy, fresh embryo transfer (ET), frozen ET, and frozen ET following preimplantation genetic testing for aneuploidy (PGT-A).
Primary outcomes included birth weight, SGA, and LGA.
Mode of conception is not independently associated with birth weight, SGA, or LGA. Mediation analysis revealed an expected one-day increase in log-transformed hCG varied by mode of conception: unassisted (0.41), fresh ET (0.39), frozen ET (0.42), PGT-A (0.44). Human chorionic gonadotropin rise has a positive effect on birth weight (55 g per SD increase in hCG slope) and is associated with SGA (odds ratio, 0.65), but not with LGA (odds ratio, 1.18).
Human chorionic gonadotropin rise is an important mediator of the mode of conception/birth weight relationship. Preimplantation genetic testing for aneuploidy has the highest rate of hCG rise, followed by frozen ET, unassisted, and fresh ET. Faster rise is associated with higher birth weight and lower risk of SGA but does not impact LGA risk. Importantly, PGT-A does not increase the risk of extreme birth weight relative to other modes of conception evaluated.
评估受孕方式和胚胎活检是否会影响孕早期人绒毛膜促性腺激素（hCG）动态变化以及随后出现小于胎龄儿（SGA）或大于胎龄儿（LGA）的风险。
回顾性队列研究。
大学附属生育中心。
602名单胎活产的孕妇。
在受孕后10至28天之间进行系列血清hCG测量，以按受孕方式（自然受孕、新鲜胚胎移植（ET）、冷冻胚胎移植以及植入前非整倍体遗传学检测（PGT-A）后的冷冻胚胎移植）确定女性体内hCG的变化率（斜率）。
主要结局包括出生体重、SGA和LGA。
受孕方式与出生体重、SGA或LGA无独立相关性。中介分析显示，经对数转换的hCG预期每日增加量因受孕方式而异：自然受孕（0.41）、新鲜胚胎移植（0.39）、冷冻胚胎移植（0.42）、PGT-A（0.44）。hCG升高对出生体重有正向影响（hCG斜率每增加1个标准差，出生体重增加55克），且与SGA相关（优势比，0.65），但与LGA无关（优势比，1.18）。
hCG升高是受孕方式与出生体重关系的重要中介因素。植入前非整倍体遗传学检测的hCG升高率最高，其次是冷冻胚胎移植、自然受孕和新鲜胚胎移植。升高速度越快，出生体重越高，SGA风险越低，但不影响LGA风险。重要的是，相对于所评估的其他受孕方式，PGT-A不会增加极低出生体重的风险。
