基于前瞻性队列研究体外受精-胚胎移植对不良妊娠结局的影响

目的：评价体外受精-胚胎移植(in vitro fertilization-embryo transfer，IVF-ET)技术本身是否会增加子代不良妊娠结局(adverse pregnancy outcomes，APOs)的风险。方法：选择诊断为不孕症通过IVF-ET受孕的妇女为暴露组，诊断为不孕症但通过非辅助生殖技术治疗(如促排卵或简单药物治疗)后自然怀孕的妇女作为非暴露组，建立前瞻性队列。通过单因素分析找出两组除IVF-ET操作因素外存在差异的因素，再采用多因素logistic回归分析控制这些因素，分析IVF-ET技术对APOs的独立作用。结果：多因素logistic回归分析显示，在控制混杂因素后，IVF-ET受孕孕妇较诊断为不孕症但自然受孕孕妇显著增加早产(OR=1.28，95% CI：1.05~1.56)、低出生体重(OR=1.69，95% CI：1.27~2.31)、围生期死亡(OR=5.33，95% CI：2.44~11.81)和先天畸形(OR=1.83，95% CI：1.12~2.94)的风险。结论：IVF-ET操作因素本身可能会增加APOs的风险。

Impact of in vitro fertilization-embryo transfer on adverse pregnancy outcomes: A prospective cohort study

Objective: To evaluate whether the in vitro fertilization-embryo transfer (IVF-ET) procedurescould increases the risks of adverse pregnancy outcomes (APOs) in off spring.Methods: A hospital-based prospective cohort design was conducted, which contained a controlgroup of singleton pregnancies with indicators of subfertility who were still conceived naturallyaft er using simple medical treatment (e.g. minimal medical intervention or ovulation induction),and an exposure group consisted of singleton pregnancies who had a history of infertility and IVFETtreatment. All factors different between two groups in the univariate analysis were includedin the multivariable logistic regression to evaluate the independent effect of IVF-ET procedures themselves on APOs.Results: After controlling for confounding factors by using multivariate logistic regression analysis,our results showed that pregnancies after IVF-ET experienced a higher risk of preterm birth(OR=1.28, 95% CI 1.05 to 1.56), low birth weight (OR=1.69, 95% CI 1.27 to 2.31), perinatalmortality (OR=5.33, 95% CI 2.44 to 11.81), and congenital malformations (OR=1.83, 95% CI 1.12to 2.94).Conclusion: The IVF-ET operational factors may increase the risk of APOs.