接受辅助生殖治疗的原发性干燥综合征患者的妊娠结局：一项多中心回顾性研究。
Pregnancy Outcomes in Patients with Primary Sjögren's Syndrome Undergoing Assisted Reproductive Therapy: A Multi-center Retrospective Study.
作者信息
Lao Minxi, Luo Guangxi, Dai Peiyin, Zhang Xiaoxue, Peng Miaoguan, Chen Yuyi, Ren Hao, Wang Xiaodong, Zhan Zhongping, Chen Dongying
机构信息
Department of Rheumatology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
Department of Ultrasound, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
出版信息
Rheumatol Ther. 2023 Dec;10(6):1725-1739. doi: 10.1007/s40744-023-00608-3. Epub 2023 Oct 24.
INTRODUCTION
The aim of this work was to investigate the pregnancy outcomes in infertile patients with primary Sjögren's syndrome (pSS) undergoing assisted reproductive therapy (ART).
METHODS
A multi-center retrospective study was performed in pregnant women with pSS and ART from five tertiary hospitals from Guangdong Province from 2013 to 2022. Natural planned pregnancy in pSS and healthy people undergoing ART were selected as controls. Pregnancy outcomes were collected from medical records and compared among groups.
RESULTS
Twenty-four pregnancies in pSS with ART, 70 natural planned pregnancies in pSS, and 96 pregnancies in healthy people with ART were analyzed. More than half of the pSS mothers undergoing ART have a past history of adverse pregnancy and spontaneous abortion was the most common (10/24, 41.7%). Primary infertility (25.0%) and recurrent spontaneous abortion (16.7%) were the leading causes of infertility in pSS. The major maternal adverse pregnancy outcome (APO) in pSS patients with ART was premature delivery (11/24, 45.8%), likely attributed to twin gestation (4/11, 36.4%) and fetal distress (3/11, 27.3%). Twenty-seven live infants were born from 22 successful deliveries. The live birth rate was 93.1% (27/29). The average delivery time was 36.1 ± 3.3 weeks of gestation. The average birthweight was 2434.4 ± 722.1 g, compared with 2844.9 g in natural planned pregnancy in pSS, and 3072.1 g from healthy mothers with ART (P < 0.001). Seven (25.9%) low-birthweight (LBW) infants were born, and the incidence was comparable to the other two groups (22.2% in natural pregnancy, 13.0% in healthy people, P = 0.09). No infants developed congenital heart block (CHB).
CONCLUSIONS
ART is an effective method for infertility in patients with pSS. Premature delivery is the leading maternal APOs. The incidence of fetal APOs does not increase, while birthweight is lower in offspring from pSS mothers with ART.
引言
本研究旨在调查原发性干燥综合征（pSS）不孕患者接受辅助生殖治疗（ART）后的妊娠结局。
方法
对2013年至2022年来自广东省五家三级医院的接受ART的pSS孕妇进行了一项多中心回顾性研究。选择pSS自然计划妊娠者和接受ART的健康人作为对照。从病历中收集妊娠结局并在各组之间进行比较。
结果
分析了24例接受ART的pSS妊娠、70例pSS自然计划妊娠和96例接受ART的健康人妊娠。超过一半接受ART的pSS母亲有不良妊娠史，自然流产最为常见（10/24，41.7%）。原发性不孕（25.0%）和复发性自然流产（16.7%）是pSS不孕的主要原因。接受ART的pSS患者主要的孕产妇不良妊娠结局（APO）是早产（11/24，45.8%），可能归因于双胎妊娠（4/11，36.4%）和胎儿窘迫（3/11，27.3%）。22例成功分娩共出生27名活婴。活产率为93.1%（27/29）。平均分娩孕周为36.1±3.3周。平均出生体重为2434.4±722.1g，与pSS自然计划妊娠的2844.9g以及接受ART的健康母亲的3072.1g相比（P<0.001）。出生了7例（25.9%）低出生体重（LBW）婴儿，其发生率与其他两组相当（自然妊娠组为22.2%，健康人组为13.0%，P=0.09）。没有婴儿发生先天性心脏传导阻滞（CHB）。
结论
ART是治疗pSS患者不孕的有效方法。早产是主要的孕产妇APO。胎儿APO的发生率没有增加，但接受ART的pSS母亲所生后代的出生体重较低。
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