Department of Obstetrics and Gynecology and Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, Massachusetts.
Fertil Steril. 2022 Jun;117(6):1223-1234. doi: 10.1016/j.fertnstert.2022.02.009. Epub 2022 Apr 7.
To determine whether assisted reproductive technology (ART) treatment adds obstetric and neonatal risks over and above that of underlying infertility-related diagnoses.
Retrospective study of linked ART, birth certificate, hospital discharge data, and outpatient insurance claims data in Massachusetts (2013-2017).
Database.
PATIENT(S): Singleton deliveries in women with and without diagnoses of tubal disease, polycystic ovarian syndrome (PCOS), other ovulatory conditions, or endometriosis, identified from the insurance claims and ART data.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): ART and non-ART pregnancy and delivery outcomes were compared with each other and with women with no history of infertility or usage of fertility treatment (fertile group). Generalizing estimating equations with Poisson distribution and exchangeable correlation structure were used to obtain adjusted relative risk ratios (aRRs) and 95% confidence intervals (CIs).
RESULT(S): Infertility-related diagnoses significantly increased the risks of pregnancy hypertension (PCOS: aRR, 1.13, 95% CI 1.00-1.27), preeclampsia/eclampsia (tubal: aRR 1.28, 95% CI 1.02-1.61; PCOS: aRR 1.23, 95% CI 1.06-1.43; other ovulatory: aRR 1.11, 95% CI 1.02-1.20), gestational diabetes (tubal: aRR 1.28, 95% CI 1.08-1.50; PCOS: aRR 1.58, 95% CI 1.42-1.75; other ovulatory: aRR 1.19, 95% CI 1.12-1.26), and placental problems (tubal aRR 1.47, 95% CI 1.11-1.94), as well as low birthweight and prematurity, compared with deliveries from the fertile group. Within each diagnosis, the use of ART consistently increased the risk of placental problems (aRR 1.49-2.86) but varied for other conditions.
CONCLUSION(S): Our study demonstrated that compared with the fertile group, risk was elevated in pregnancies and deliveries from women with tubal, PCOS, other ovulatory, and endometriosis diagnoses who did/did not undergo ART treatment. Placental abnormalities were particularly elevated in ART compared to non-ART deliveries having the same diagnosis.
确定辅助生殖技术（ART）治疗是否会增加产科和新生儿风险，超过潜在不孕相关诊断的风险。
马萨诸塞州（2013-2017 年）的 ART、出生证明、医院出院数据和门诊保险索赔数据的回顾性研究。
数据库。
保险索赔和 ART 数据中患有输卵管疾病、多囊卵巢综合征（PCOS）、其他排卵情况或子宫内膜异位症的女性，以及没有不孕或使用生育治疗史的女性（生育组）的单胎分娩。
无。
比较了 ART 和非 ART 妊娠和分娩结局，并与没有不孕或使用生育治疗史的女性（生育组）进行了比较。使用具有泊松分布和可交换相关结构的广义估计方程获得调整后的相对风险比（aRR）和 95%置信区间（CI）。
不孕相关诊断显著增加了妊娠高血压（PCOS：aRR，1.13，95%CI 1.00-1.27）、子痫前期/子痫（输卵管：aRR，1.28，95%CI 1.02-1.61；PCOS：aRR，1.23，95%CI 1.06-1.43；其他排卵：aRR，1.11，95%CI 1.02-1.20）、妊娠期糖尿病（输卵管：aRR，1.28，95%CI 1.08-1.50；PCOS：aRR，1.58，95%CI 1.42-1.75；其他排卵：aRR，1.19，95%CI 1.12-1.26）和胎盘问题（输卵管：aRR，1.47，95%CI 1.11-1.94）的风险，与生育组的分娩相比。在每个诊断中，ART 的使用都会增加胎盘问题的风险（aRR 1.49-2.86），但其他情况则有所不同。
与生育组相比，患有输卵管、PCOS、其他排卵和子宫内膜异位症诊断的女性，无论是否接受 ART 治疗，其妊娠和分娩的风险都有所升高。与具有相同诊断的非 ART 分娩相比，ART 中胎盘异常尤其升高。
