IVI-RMA Roma, Rome, Italy.
Fundación IVI, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
Hum Reprod. 2023 Aug 1;38(8):1621-1627. doi: 10.1093/humrep/dead123.
What is the potential impact of preimplantation genetic testing for aneuploidy (PGT-A) on obstetric and neonatal outcomes?
PGT-A is not associated with increased rates of adverse maternal and neonatal outcomes in singleton pregnancies following IVF/ICSI cycles.
PGT-A pregnancies may be associated with increased risks of lower birthweight, preterm delivery, and hypertensive disorders compared with natural pregnancies. In a recent meta-analysis, the overall obstetric and neonatal outcomes of PGT-A pregnancies were favorable compared with those of IVF/ICSI pregnancies, although PGT-A pregnancies were associated with a higher risk of hypertensive disorders.
STUDY DESIGN, SIZE, DURATION: A multicenter retrospective cohort study was performed in University-affiliated infertility centers. Single live births following IVF/ICSI between October 2016 and January 2021 were included in the study.
PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 7146 live births after single embryo transfers with (n = 3296) or without (n = 3850) PGT-A were included. The primary outcome was pre-eclampsia and secondary outcomes included gestational diabetes, low birthweight and very low birthweight, cesarean section delivery, emergency cesarean section, as well as preterm birth, birthweight, congenital abnormalities, neonatal sex, Apgar score at 5 min, and neonatal intensive care unit admission. In a subgroup analysis, were included only blastocysts screened with next-generation sequencing (NGS).
Univariate analysis showed that pre-eclampsia, cesarean section incidence, and low Apgar score were higher in women undergoing PGT-A. However, after performing multivariate logistic and linear regression models accounting for many possible confounders, pregnancies that had been conceived after embryo biopsy showed no increase in adverse obstetric and neonatal outcomes. The subgroup analysis including patients with blastocysts screened by NGS showed a decreased risk of preterm birth in the group undergoing PGT-A.
LIMITATIONS, REASONS FOR CAUTION: Caution should be used when interpreting the data because of its limitations, mainly related to its retrospective design. Although this is a large multicenter study, data acquisition included self-reporting questionnaires, and the deliveries occurred in different institutions with distinct protocols.
The current study does not show any major adverse clinical outcomes after PGT-A. Efforts should be made to promote good quality research on embryo biopsy in terms of neonatal and obstetric outcomes, as well as its long-term consequences.
STUDY FUNDING/COMPETING INTEREST(S): No specific funding was obtained for this study. The authors declare no conflicts of interest.
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胚胎植入前遗传学检测（PGT-A）对产科和新生儿结局的潜在影响是什么？
PGT-A 并不增加体外受精/卵胞浆内单精子注射（IVF/ICSI）周期后单胎妊娠的不良母婴结局发生率。
与自然妊娠相比，PGT-A 妊娠可能与较低的出生体重、早产和高血压疾病风险增加有关。在最近的一项荟萃分析中，与 IVF/ICSI 妊娠相比，PGT-A 妊娠的整体产科和新生儿结局更为有利，尽管 PGT-A 妊娠与高血压疾病风险增加有关。
研究设计、规模、持续时间：这是一项在大学附属不孕不育中心进行的多中心回顾性队列研究。纳入了 2016 年 10 月至 2021 年 1 月期间进行的 IVF/ICSI 后单胚胎移植的活产单胎妊娠。
参与者/材料、设置、方法：共纳入 7146 例接受或未接受 PGT-A 的单胚胎移植的活产儿。主要结局是子痫前期，次要结局包括妊娠期糖尿病、低出生体重和极低出生体重、剖宫产、急症剖宫产，以及早产、出生体重、先天性异常、新生儿性别、5 分钟时的 Apgar 评分和新生儿重症监护病房入院。在亚组分析中，仅纳入使用下一代测序（NGS）筛查的囊胚。
单变量分析显示，接受 PGT-A 的女性发生子痫前期、剖宫产率和低 Apgar 评分较高。然而，在进行多变量逻辑回归和线性回归模型以考虑许多可能的混杂因素后，胚胎活检后受孕的妊娠并未增加不良产科和新生儿结局的风险。包括接受 NGS 筛查囊胚的患者的亚组分析显示，PGT-A 组的早产风险降低。
局限性、谨慎的原因：由于其回顾性设计，其数据存在一定局限性，在解释数据时应谨慎。尽管这是一项大型多中心研究，但数据采集包括自我报告的问卷，分娩发生在具有不同协议的不同机构。
目前的研究显示 PGT-A 后没有任何主要的临床不良结局。应努力促进胚胎活检在新生儿和产科结局及其长期后果方面的高质量研究。
研究资助/利益冲突：本研究未获得特定资金。作者声明没有利益冲突。
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