Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China.
International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Front Endocrinol (Lausanne). 2023 Feb 21;14:1081069. doi: 10.3389/fendo.2023.1081069. eCollection 2023.
Anti-Müllerian hormone (AMH) level has long been considered as a serum biomarker of ovarian reserve clinically, while emerging data suggest that serum AMH level may also predict pregnancy outcomes. However, whether pregestational serum AMH levels are related to perinatal outcomes among women undergoing fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles is unknown.
To explore the association between different AMH levels and perinatal outcomes in women with live births in IVF/ICSI.
This multicenter retrospective cohort study was conducted among three different provinces in China, from January 2014 to October 2019. A total of 13,763 IVF/ICSI cycles with 5657 live-delivery pregnant women and 6797 newborns were recruited. Participants were categorized into three groups according to the <25th (low), 25 to 75th (average), and >75th (high) percentile of serum AMH concentration. Perinatal outcomes were compared among groups. Subgroup analyses were conducted based on the number of live births.
Among women with singleton deliveries, low and high AMH levels increased the risk of intrahepatic cholestasis of pregnancy (ICP) (aOR1 = 6.02, 95%CI: 2.10-17.22; aOR2 = 3.65, 95%CI:1.32-10.08) and decreased the risk of macrosomia (aOR1 = 0.65, 95%CI:0.48-0.89; aOR2 = 0.72, 95%CI:0.57-0.96), while low AMH reduced the risk of large for gestational age (LGA, aOR=0.74, 95%CI:0.59-0.93) and premature rupture of membrane (PROM, aOR=0.50, 95%CI:0.31-0.79)compared with the average AMH group. In women with multiple deliveries, high AMH levels increased the risks of gestational diabetes mellitus (GDM, aOR=2.40, 95%CI:1.48-3.91) and pregnancy-induced hypertension (PIH, aOR=2.26, 95%CI:1.20-4.22) compared with the average AMH group, while low AMH levels increased the risk of ICP (aOR=14.83, 95%CI:1.92-54.30). However, there was no evidence of differences in preterm birth, congenital anomaly, and other perinatal outcomes among the three groups in both singleton and multiple deliveries.
Abnormal AMH levels increased the risk of ICP regardless of the number of live births for women undergoing IVF/ICSI, while high AMH levels increased the risks of GDM and PIH in multiple deliveries. However, serum AMH levels were not associated with adverse neonatal outcomes in IVF/ICSI. The underlying mechanism warrants further investigation.
抗苗勒管激素（AMH）水平长期以来一直被认为是临床卵巢储备的血清生物标志物，而新出现的数据表明，血清 AMH 水平也可能预测妊娠结局。然而，在接受体外受精（IVF）/卵胞浆内单精子注射（ICSI）周期的女性中，孕前血清 AMH 水平是否与围产期结局相关尚不清楚。
探讨不同 AMH 水平与 IVF/ICSI 活产女性围产期结局的关系。
本多中心回顾性队列研究在中国三个不同省份进行，时间为 2014 年 1 月至 2019 年 10 月。共纳入 13763 个 IVF/ICSI 周期，其中 5657 名活产孕妇和 6797 名新生儿。根据血清 AMH 浓度的<25 百分位（低）、25-75 百分位（中）和>75 百分位（高），将参与者分为三组。比较各组围产期结局。根据活产数进行亚组分析。
在单胎分娩的女性中，低和高 AMH 水平增加了妊娠肝内胆汁淤积症（ICP）的风险（aOR1=6.02，95%CI：2.10-17.22；aOR2=3.65，95%CI：1.32-10.08），降低了巨大儿（aOR1=0.65，95%CI：0.48-0.89；aOR2=0.72，95%CI：0.57-0.96）的风险，而低 AMH 降低了巨大儿（aOR=0.74，95%CI：0.59-0.93）和胎膜早破（PROM，aOR=0.50，95%CI：0.31-0.79）的风险与平均 AMH 组相比。在多胎分娩的女性中，高 AMH 水平增加了妊娠期糖尿病（GDM，aOR=2.40，95%CI：1.48-3.91）和妊娠高血压（PIH，aOR=2.26，95%CI：1.20-4.22）的风险与平均 AMH 组相比，而低 AMH 水平增加了 ICP（aOR=14.83，95%CI：1.92-54.30）的风险。然而，在单胎和多胎分娩的三组中，均未发现早产、先天畸形和其他围产期结局的差异。
无论活产数如何，异常 AMH 水平均增加了 ICP 的风险，而高 AMH 水平增加了多胎分娩时 GDM 和 PIH 的风险。然而，血清 AMH 水平与 IVF/ICSI 新生儿不良结局无关。其潜在机制需要进一步研究。
