Londero Ambrogio P, Massarotti Claudia, Xholli Anjeza, Fruscalzo Arrigo, Cagnacci Angelo
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DiNOGMI), University of Genoa, 16132 Genova, Italy.
Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy.
J Pers Med. 2023 Jul 16;13(7):1144. doi: 10.3390/jpm13071144.
Since essential factors have changed in recent years in assisted reproduction technologies (ARTs), this study reassessed the association between ART and breech presentation. We primarily aimed to estimate the correlation between ART and breech at delivery. Secondary purposes were to evaluate the correlation between other subfertility treatments (OSTs) and breech and to assess possible confounding factors and temporal trends. This study investigated the 31,692,729 live birth certificates from US states and territories in the 2009-2020 period. The inclusion criteria were singleton births reporting the method of conception and the presentation at delivery. The outcome was the breech presentation at delivery, while the primary exposure was ART, the secondary exposure was OST, and the potential confounding factors from the literature were considered. ART (OR 2.32 CI.95 2.23-2.41) and OST (OR 1.79 CI.95 1.71-1.87) were independent and significant risk factors for breech at delivery ( < 0.001). This study confirmed breech presentation risk factors maternal age, nulliparity, tobacco smoke, a previous cesarean delivery (CD), neonatal female sex, gestational age, and birth weight. Black race and Hispanic origin were verified to be protective factors. We found breech prevalence among ART and OST to be stable during the study period. Meanwhile, newborn birth weight was increased, and the gap between breech and other presentations in ART was reduced. Our results indicate that singleton pregnancies conceived by ART or OST were associated with a higher risk of breech at delivery. Well-known risk factors for the breech presentation were also confirmed. Some of these factors can be modified by implementing interventions to reduce their prevalence (e.g., tobacco smoke and previous CD).
由于近年来辅助生殖技术（ART）中的关键因素发生了变化，本研究重新评估了ART与臀位分娩之间的关联。我们的主要目的是估计ART与分娩时臀位之间的相关性。次要目的是评估其他不育治疗（OST）与臀位之间的相关性，并评估可能的混杂因素和时间趋势。本研究调查了2009年至2020年期间美国各州和领地的31,692,729份出生证明。纳入标准为报告受孕方式和分娩时胎位的单胎分娩。结局是分娩时的臀位，而主要暴露因素是ART，次要暴露因素是OST，并考虑了文献中的潜在混杂因素。ART（OR 2.32，CI.95 2.23 - 2.41）和OST（OR 1.79，CI.95 1.71 - 1.87）是分娩时臀位的独立且显著的危险因素（<0.001）。本研究证实了臀位分娩的危险因素包括产妇年龄、未生育、吸烟、既往剖宫产（CD）、新生儿女性性别、孕周和出生体重。黑人种族和西班牙裔血统被证实为保护因素。我们发现，在研究期间，ART和OST中的臀位患病率保持稳定。与此同时，新生儿出生体重增加，ART中臀位与其他胎位之间的差距缩小。我们的结果表明，通过ART或OST受孕的单胎妊娠与分娩时臀位的较高风险相关。臀位分娩的一些已知危险因素也得到了证实。其中一些因素可以通过实施干预措施来降低其患病率（例如，吸烟和既往剖宫产）。
