Department of Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617 Riyue Avenue, Qingyang District, Chengdu, 611731, P.R. China.
BMC Pregnancy Childbirth. 2023 May 25;23(1):385. doi: 10.1186/s12884-023-05694-3.
Assisted reproductive technology (ART) has been widely used in the treatment of infertility, and is associated with adverse maternal and neonatal outcomes. However, the potential pathways by which ART affects adverse neonatal outcomes are unclear. We aimed to investigate the role of pregnancy-induced hypertension (PIH) in the association between ART and adverse neonatal outcomes.
Adult women (aged ≥ 18 years) with a singleton pregnancy in the National Vital Statistics System (NVSS) 2020 were enrolled in this retrospective cohort study. Study outcomes were adverse neonatal outcomes, including premature birth, low birth weight, and admission to the neonatal intensive care unit (NICU). Logistic regression models were utilized to investigate the association between ART, PIH, and adverse neonatal outcomes, expressed as odds ratio (OR) and 95% confidence interval (CI). The distribution-of-the-product method was used to explore whether there was a mediating effect of PIH between ART and adverse neonatal outcomes, and the 95% CI of the distribution-of-the-product did not contain 0 indicating a mediating effect.
This study included 2,824,418 women, of whom 35,020 (1.24%) women used ART, 239,588 (8.48%) women had PIH, and 424,741 (15.04%) neonates had any adverse neonatal outcomes. The use of ART was associated with higher odds of PIH (OR = 1.42; 95%CI: 1.37-1.46) and any adverse neonatal outcomes (OR = 1.47; 95%CI: 1.43-1.51). The distribution-of-the-product was 0.31 (95%CI: 0.28-0.34), and 8.51% of the association between ART and adverse neonatal outcomes was mediated through PIH. Among different adverse neonatal outcomes, PIH mediated 29.17% of the association between ART and low birth weight, 9.37% of the association between ART and premature birth, and 12.20% of the association between ART and NICU admission. The mediating effect of PIH was found in women of different ages (< 35 years and ≥ 35 years) and parities (primipara and multipara).
This study supports a mediating role for PIH in the association between ART and adverse neonatal outcomes. Further studies are needed to determine the mechanisms by which AR affects PIH so that interventions to reduce PIH can be developed to reduce adverse neonatal outcomes associated with ART.
辅助生殖技术（ART）已广泛应用于不孕不育的治疗，并与不良的母婴和新生儿结局相关。然而，ART 影响不良新生儿结局的潜在途径尚不清楚。我们旨在探讨妊娠高血压（PIH）在 ART 与不良新生儿结局之间的关系中的作用。
本回顾性队列研究纳入了 2020 年国家生命统计系统（NVSS）中年龄≥18 岁的单胎妊娠的成年女性。研究结局为不良新生儿结局，包括早产、低出生体重和新生儿重症监护病房（NICU）入院。使用 logistic 回归模型来探讨 ART、PIH 与不良新生儿结局之间的关联，结果表示为比值比（OR）和 95%置信区间（CI）。分布乘积法用于探索 PIH 在 ART 和不良新生儿结局之间是否存在中介作用，分布乘积的 95%CI 不包含 0 表示存在中介作用。
本研究共纳入了 2824418 名女性，其中 35020（1.24%）名女性使用了 ART，239588（8.48%）名女性患有 PIH，424741（15.04%）名新生儿出现任何不良新生儿结局。使用 ART 与 PIH（OR=1.42；95%CI：1.37-1.46）和任何不良新生儿结局（OR=1.47；95%CI：1.43-1.51）的发生风险较高相关。分布乘积为 0.31（95%CI：0.28-0.34），ART 和不良新生儿结局之间的关联有 8.51%是通过 PIH 介导的。在不同的不良新生儿结局中，PIH 介导了 ART 和低出生体重之间关联的 29.17%、ART 和早产之间关联的 9.37%、ART 和 NICU 入院之间关联的 12.20%。PIH 的中介作用在不同年龄（<35 岁和≥35 岁）和产次（初产妇和经产妇）的女性中均存在。
本研究支持 PIH 在 ART 和不良新生儿结局之间的关联中起中介作用。需要进一步的研究来确定 AR 影响 PIH 的机制，以便开发减少 PIH 的干预措施，从而降低与 ART 相关的不良新生儿结局。
