Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
Fertil Steril. 2022 Nov;118(5):894-903. doi: 10.1016/j.fertnstert.2022.08.013. Epub 2022 Sep 27.
To define specific risk factors for placenta previa in pregnancies conceived with assisted reproductive technology (ART).
Retrospective cohort.
Fertility centers and inpatient obstetric units in Massachusetts.
PATIENT(S): Patients conceiving with ART and delivering at 20 weeks gestation or later between 2011 and 2017 in Massachusetts.
INTERVENTION(S): Patient demographic and medical factors and specific components of their cycles. Data were obtained by linking vital records of the State of Massachusetts to reproductive clinic data obtained from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System, and then supplementing this information with laboratory and obstetric data from 2 large academic hospitals.
Associations were tested between multiple cycle- and patient-related factors and placenta previa or low-lying placenta at delivery. After testing for confounders, multivariate models were adjusted for maternal age, history of prior cesarean delivery and birth plurality, and are reported as adjusted relative risks (aRR).
RESULT(S): We included 18,939 pregnancies, with 553 (2.9%) having placenta previa at delivery. Advanced maternal age (aRR, 1.25; 95% confidence interval [CI], 1.06-1.48), endometriosis, (aRR, 2.22; 95% CI, 1.71-2.86), and controlled ovarian hyperstimulation (aRR, 1.33; 95% CI, 1.12-1.59) were associated with placenta previa, whereas multiple births (aRR, 0.63; 95% CI, 0.48-0.81) and a history of polycystic ovary syndrome or ovulation disorders (aRR, 0.59; 95% CI, 0.46-0.75) had negative associations. The endometriosis association was strong in nulliparas and the controlled ovarian hyperstimulation association was strong in parous patients in a stratified analysis. No association was seen with prior history of cesarean delivery.
CONCLUSION(S): Patients conceiving with ART do not have the typical previa risk factors of prior cesarean delivery and multiple gestations, whereas endometriosis and fresh embryo transfers contributed moderate risk. The embryo transfer process itself may affect previa development in this population.
确定与辅助生殖技术（ART）受孕相关的胎盘前置的具体危险因素。
回顾性队列研究。
马萨诸塞州的生育中心和住院产科单位。
2011 年至 2017 年间在马萨诸塞州妊娠 20 周或以上并分娩的接受 ART 受孕的患者。
患者的人口统计学和医疗因素以及他们周期的具体组成部分。通过将马萨诸塞州的生命记录与从辅助生殖技术协会的生殖诊所结果报告系统获得的生殖诊所数据相关联来获取数据，然后利用 2 家大型学术医院的实验室和产科数据对这些信息进行补充。
测试多个与周期和患者相关的因素与分娩时胎盘前置或低位胎盘之间的关系。在对混杂因素进行检验后，对多变量模型进行了调整，以调整产妇年龄、既往剖宫产分娩和分娩次数，并用调整后的相对风险（aRR）表示。
我们纳入了 18939 例妊娠，其中 553 例（2.9%）在分娩时患有胎盘前置。高龄（aRR，1.25；95%置信区间[CI]，1.06-1.48）、子宫内膜异位症（aRR，2.22；95%CI，1.71-2.86）和控制性卵巢过度刺激（aRR，1.33；95%CI，1.12-1.59）与胎盘前置相关，而多胎妊娠（aRR，0.63；95%CI，0.48-0.81）和多囊卵巢综合征或排卵障碍病史（aRR，0.59；95%CI，0.46-0.75）则呈负相关。在分层分析中，子宫内膜异位症在初产妇中相关性较强，控制性卵巢过度刺激在经产妇中相关性较强。既往剖宫产史与胎盘前置无关。
接受 ART 受孕的患者没有典型的前置胎盘危险因素，如既往剖宫产和多胎妊娠，而子宫内膜异位症和新鲜胚胎移植则增加了中度风险。胚胎移植过程本身可能会影响这一人群的前置胎盘的发生。
