Siargkas Antonios, Tsakiridis Ioannis, Faka Areti, Kappou Dimitra, Papastefanou Ioannis, Dagklis Themistoklis
Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
Institute of Life, IASO General Hospital, 15123 Athens, Greece.
Diagnostics (Basel). 2025 Aug 29;15(17):2192. doi: 10.3390/diagnostics15172192.
Uterine artery pulsatility index (UtA-PI) is a key biomarker of placental function, but its clinical interpretation in assisted reproductive technology (ART) pregnancies is uncertain. This meta-analysis aimed to assess trimester- and method-specific UtA-PI differences between ART and spontaneous conceptions (SC) and to examine associated risks for preeclampsia (PE) and small-for-gestational-age (SGA) neonates to contextualize its findings. A systematic search of MEDLINE, Scopus, and the Cochrane Library was conducted through 25 June 2025. We included observational studies comparing UtA-PI and perinatal outcomes in singleton ART versus SC pregnancies. The primary outcome was the standardized mean difference (SMD) in first (until the 13 gestational week) and second trimester (14-23 gestational weeks) UtA-PI measurements; secondary outcomes were PE and SGA rates. Analyses were stratified by ART modalities. Random-effects models were used, and study quality was evaluated using the Newcastle-Ottawa Scale and risk of bias with QUIPS tool (INPLASY registration: INPLASY202560104). Thirteen cohort studies were included. Overall, ART pregnancies had significantly lower UtA-PI values than SC in both the first (SMD = -0.28; 95% CI: -0.53 to -0.03) and second trimesters (SMD = -0.20; 95% CI: -0.36 to -0.04). These reductions were driven by oocyte donation (first-trimester SMD = -0.70; 95% CI: -1.21 to -0.18; second-trimester SMD = -0.46; 95% CI: -0.65 to -0.26) and artificial cycle frozen embryo transfers (ET) (first-trimester SMD = -0.69; 95% CI: -1.00 to -0.39). These lower UtA-PI values typically suggest better placental perfusion and a lower risk of placental related complications. However, ART pregnancies had an elevated overall risk for PE (risk ratio [RR] = 2.32; 95% CI: 1.72 to 3.12), with the highest risk in oocyte donation (RR = 6.11; 95% CI: 3.35 to 11.17) and artificial cycle frozen ET (RR = 3.45; 95% CI: 1.51 to 7.90). ART pregnancies, particularly from oocyte donation and artificial cycle frozen ET, show lower UtA-PI values despite a significantly elevated risk for PE. This finding suggests that mechanisms other than placental perfusion contribute to PE development. Clinically, the ART method is an independent risk factor for PE, and UtA-PI interpretation should be adjusted accordingly. Further research is crucial to elucidate the underlying pathophysiology.
子宫动脉搏动指数（UtA-PI）是胎盘功能的关键生物标志物，但其在辅助生殖技术（ART）妊娠中的临床意义尚不确定。本荟萃分析旨在评估ART与自然受孕（SC）之间按孕期和方法分类的UtA-PI差异，并研究子痫前期（PE）和小于胎龄（SGA）新生儿的相关风险，以便将研究结果置于具体情境中。通过对MEDLINE、Scopus和Cochrane图书馆进行系统检索，截止至2025年6月25日。我们纳入了比较单胎ART与SC妊娠中UtA-PI及围产期结局的观察性研究。主要结局是孕早期（直至妊娠第13周）和孕中期（妊娠第14 - 23周）UtA-PI测量值的标准化均数差（SMD）；次要结局是PE和SGA发生率。分析按ART方式进行分层。采用随机效应模型，并使用纽卡斯尔-渥太华量表和QUIPS工具评估研究质量（INPLASY注册编号：INPLASY202560104）。纳入了13项队列研究。总体而言，ART妊娠在孕早期（SMD = -0.28；95%置信区间：-0.53至-0.03）和孕中期（SMD = -0.20；95%置信区间：-0.36至-0.04）的UtA-PI值均显著低于SC妊娠。这些降低是由卵母细胞捐赠（孕早期SMD = -0.70；95%置信区间：-1.21至-0.18；孕中期SMD = -0.46；95%置信区间：-0.65至-0.26）和人工周期冷冻胚胎移植（ET）（孕早期SMD = -0.69；95%置信区间：-1.00至-0.39）导致的。这些较低的UtA-PI值通常表明胎盘灌注更好，胎盘相关并发症风险更低。然而，ART妊娠发生PE的总体风险升高（风险比[RR] = 2.32；95%置信区间：1.72至3.12），其中卵母细胞捐赠的风险最高（RR = 6.11；95%置信区间：3.35至11.17），人工周期冷冻ET的风险为（RR = 3.45；95%置信区间：1.51至7.90）。尽管PE风险显著升高，但ART妊娠，尤其是来自卵母细胞捐赠和人工周期冷冻ET的妊娠，UtA-PI值较低。这一发现表明，除胎盘灌注外的其他机制也参与了PE的发生发展。临床上，ART方法是PE的独立危险因素，UtA-PI的解释应相应调整。进一步的研究对于阐明潜在的病理生理学至关重要。
