Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.
BMC Pregnancy Childbirth. 2023 Mar 4;23(1):141. doi: 10.1186/s12884-023-05466-z.
With the wide application of preimplantation genetic testing (PGT) with trophectoderm (TE) biopsy, the safety of PGT has always been a concern. Since TE subsequently forms the placenta, it is speculated that the removal of these cells was associated with adverse obstetrical or neonatal outcomes after single frozen-thawed blastocyst transfer (FBT). Previous studies report contradictory findings with respect to TE biopsy and obstetric and neonatal outcomes.
We conducted a retrospective cohort study including 720 patients with singleton pregnancies from single FBT cycles who delivered at the same university-affiliated hospital between January 2019 and March 2022. The cohorts were divided into two groups: the PGT group (blastocysts with TE biopsy, n = 223) and the control group (blastocysts without biopsy, n = 497). The PGT group was matched with the control group by propensity score matching (PSM) analysis at a ratio of 1:2. The enrolled sample sizes in the two groups were 215 and 385, respectively.
Patient demographic characteristics were comparable between the groups after PSM except for the proportion of recurrent pregnancy loss, which was significantly higher in the PGT cohort (31.2 vs. 4.2%, P < 0.001). Patients in the PGT group had significantly higher rates of gestational hypertension (6.0 vs. 2.6%, adjusted odds ratio (aOR) 2.91, 95% confidence interval (CI) 1.18-7.18, P = 0.020) and abnormal umbilical cord (13.0 vs. 7.8%, aOR 1.94, 95% CI 1.08-3.48, P = 0.026). However, the occurrence of premature rupture of membranes (PROM) (12.1 vs. 19.7%, aOR 0.59, 95% CI 0.35-0.99, P = 0.047) was significantly lower in biopsied blastocysts than in unbiopsied embryos. There were no significant differences in regard to other obstetric and neonatal outcomes between the two groups.
Trophectoderm biopsy is a safe approach, as the neonatal outcomes from biopsied and unbiopsied embryos were comparable. Furthermore, PGT is associated with higher risks of gestational hypertension and abnormal umbilical cord but may have a protective effect on PROM.
随着卵裂期胚胎（囊胚）活检植入前遗传学检测（PGT）的广泛应用，PGT 的安全性一直备受关注。由于滋养外胚层（TE）随后形成胎盘，因此有人推测，在进行单个冷冻-解冻囊胚移植（FBT）后，去除这些细胞与不良的产科或新生儿结局有关。先前的研究报告称，TE 活检与产科和新生儿结局之间的相关性存在争议。
我们进行了一项回顾性队列研究，纳入了 2019 年 1 月至 2022 年 3 月期间在同一所大学附属医院分娩的 720 名接受单 FBT 周期的单胎妊娠患者。这些患者被分为两组：PGT 组（囊胚进行 TE 活检，n=223）和对照组（囊胚不活检，n=497）。通过倾向评分匹配（PSM）分析，PGT 组与对照组按 1:2 的比例进行匹配。两组的纳入样本量分别为 215 例和 385 例。
PSM 后两组患者的人口统计学特征无差异，但复发性妊娠丢失的比例明显更高，PGT 组为 31.2%，对照组为 4.2%（P<0.001）。PGT 组患者的妊娠期高血压（6.0%比 2.6%，调整后的优势比（aOR）2.91，95%置信区间（CI）1.18-7.18，P=0.020）和脐带异常（13.0%比 7.8%，aOR 1.94，95%CI 1.08-3.48，P=0.026）的发生率明显更高。然而，活检囊胚胎膜早破（PROM）的发生率（12.1%比 19.7%，aOR 0.59，95%CI 0.35-0.99，P=0.047）明显低于未活检的胚胎。两组间其他产科和新生儿结局无显著差异。
TE 活检是一种安全的方法，因为活检和未活检的胚胎的新生儿结局相当。此外，PGT 与妊娠期高血压和脐带异常的风险增加有关，但可能对 PROM 有保护作用。
