Centre for Reproductive Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
International Institutes of Medicine, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China.
Front Endocrinol (Lausanne). 2024 Jan 25;15:1351991. doi: 10.3389/fendo.2024.1351991. eCollection 2024.
Assisted reproductive technology (ART) has been reported to have negative effects on maternal and neonatal health. Ovulation induction (OI) was reported to be associated with alteration of epigenetic modification of mice embryos, and extinguishing the influence of ovulation induction and operations on maternal and neonatal health will bring benefits for reducing side effects. The present study aimed to determine whether ovulation induction alone and ART are associated with adverse pregnancy outcomes and whether ART could induce a higher risk than ovulation induction alone.
A total of 51,172 cases with singleton live birth between Jan 2016 and May 2019 at the International Peace Maternal and Child Health Hospital were included in this study. Conception modes documented during registration were classified into natural conception (NC), OI, and ART. Pregnancy outcomes of the three groups with balanced baseline characteristics by propensity score matching were compared. The relative risks of maternal and neonatal outcomes were calculated by logistic regression analysis.
Compared with natural conception, infertility treatments are associated with gestational diabetes (OI: OR 1.72, 95% CI 1.31-2.27; ART: OR 1.67, 95% CI 1.26-2.20), preeclampsia/eclampsia (OI: OR 1.86, 95% CI 1.03-3.36; ART: OR 2.23, 95% CI 1.26-3.92). Even if gestational diabetes, gestational hypertension, and placental problems were adjusted, infertility treatments are associated with birth before 37 weeks (OI: OR 1.99, 95% CI 1.28-3.12; ART: OR 1.70, 95% CI 1.08-2.69), low birth weight (OI: OR 2.19, 95% CI 1.23-3.91; ART: OR 1.90, 95% CI 1.05-3.45), and SGA (OI: OR 2.42, 95% CI 1.20-4.87; ART: OR 2.56, 95% CI 1.28-5.11). ART but not OI is associated with a higher risk of birth before 34 weeks (OR:3.12, 95% CI 1.21-8.05). By comparing the OI group with the ART group, we only found that ART could induce a higher ratio of placental problems (5.0%, 26/518 vs 2.1%, 11/519, p<0.05).
Both OI and ART are associated with adverse pregnancy outcomes. ART induced comparable negative effects with OI on gestational complications, birth weight, and premature birth (<37 weeks). However, ART resulted in a higher risk of placental problems than group NC and OI. The incidence of birth before 34 weeks of gestation in the ART group tends to be higher than in the OI group, but not statistically significant. The side effects of ART may originate from OI.
辅助生殖技术（ART）已被报道对母婴健康有负面影响。排卵诱导（OI）被报道与小鼠胚胎的表观遗传修饰改变有关，消除排卵诱导和操作对母婴健康的影响将带来减少副作用的好处。本研究旨在确定排卵诱导单独和 ART 是否与不良妊娠结局相关，以及 ART 是否比排卵诱导单独诱导更高的风险。
本研究纳入了 2016 年 1 月至 2019 年 5 月期间在国际和平妇幼保健院分娩的 51172 例单胎活产儿。登记时记录的受孕方式分为自然受孕（NC）、OI 和 ART。通过倾向评分匹配比较三组具有平衡基线特征的妊娠结局。通过 logistic 回归分析计算母婴结局的相对风险。
与自然受孕相比，不孕治疗与妊娠期糖尿病（OI：OR 1.72，95%CI 1.31-2.27；ART：OR 1.67，95%CI 1.26-2.20）、子痫前期/子痫（OI：OR 1.86，95%CI 1.03-3.36；ART：OR 2.23，95%CI 1.26-3.92）相关。即使调整了妊娠期糖尿病、妊娠期高血压和胎盘问题，不孕治疗仍与 37 周前分娩（OI：OR 1.99，95%CI 1.28-3.12；ART：OR 1.70，95%CI 1.08-2.69）、低出生体重（OI：OR 2.19，95%CI 1.23-3.91；ART：OR 1.90，95%CI 1.05-3.45）和 SGA（OI：OR 2.42，95%CI 1.20-4.87；ART：OR 2.56，95%CI 1.28-5.11）相关。ART 而不是 OI 与 34 周前分娩的风险增加相关（OR：3.12，95%CI 1.21-8.05）。通过比较 OI 组和 ART 组，我们只发现 ART 可诱导更高比例的胎盘问题（5.0%，26/518 与 2.1%，11/519，p<0.05）。
OI 和 ART 均与不良妊娠结局相关。ART 与 OI 对妊娠并发症、出生体重和早产（<37 周）有类似的负面影响。然而，ART 导致胎盘问题的风险高于 NC 组和 OI 组。ART 组的 34 周前分娩发生率高于 OI 组，但无统计学意义。ART 的副作用可能源于 OI。
