辅助生殖技术的出生结局

辅助生殖技术主要包括:体外受精-胚胎移植(IVF-ET)和胞浆内单精子注射(ICSI)两种,已经成为治疗不孕症的有效方法。但是通过辅助生殖技术(ART)出生的孩子的健康问题一直受到关注。就经辅助生殖技术出生的新生儿常见问题(包括早产、低出生体质量和出生缺陷)及其出生后的生长发育问题(包括神经系统及认知发育、癌症发生的风险、假性性早熟和社会心理发育)等综述。     

上海2004—2015年辅助生殖技术婴儿不良出生结局分析

目的探索辅助生殖技术(ART)妊娠分娩的新生儿不良出生结局发生情况及影响因素。方法采用数据库匹配方法,识别2004—2015年上海市出生监测数据库中ART婴儿5 858例,描述其出生特征,分析ART婴儿各种不良出生结局发生情况,并应用Poisson回归模型测算其相对危险度。结果 ART婴儿双多胎比例为35.73%,高于总体2.12%的水平。ART单胎婴儿早产、低体重和出生缺陷的发生风险均有所增高,发生率分别为8.34%、4.75%和1.65%,校正RR值分别为1.70(95%CI=1.52~1.90),1.68(95%CI=1.45~1.95)和1.66(95%CI=1.29~2.13)。ART双多胎婴儿早产、低体重和出生缺陷发生率分别为58.39%、44.19%和1.72%,与总体差异无统计学意义。结论 ART技术助孕后多胎率明显升高,ART新生儿早产、低体重和出生缺陷的风险也有所增高。     

辅助生殖技术对子代出生结局影响的回顾性分析

目的 通过对辅助生殖技术妊娠结局和子代出生结局进行回顾性分析,探讨ART技术对妊娠结局和子代出生结局的影响.方法 选取2014年1月至2019年12月在北京儿童医院顺义妇儿医院进行常规产检并接受过ART治疗的女性为病例组,选取同期正常妊娠的女性进行对照,按照与ART组女性末次月经在1个月以内、在同一年龄段选择对照人群,...     

辅助生殖技术出生儿童的生长发育

近二十余年来辅助生殖技术（ART）在世界范围内广泛开展，解决了许多夫妇的不孕问题。但这些通过ART出生的儿童与自然受孕出生儿童的生长发育是否存在明显差别引起了广泛的关注，对ART儿童不同年龄阶段的生长发育及常规体外受精-胚胎移植（IVF-ET）、胞浆内单精子注射（ICSI）、冻融胚胎移植技术等ART妊娠出生的儿童的发育状况进行论述。目前资料表明ART本身对儿童的生长发育无明显影响。     

辅助生殖技术予代的围生结局研究进展

辅助生殖技术（assisted reproductive technology,ART）作为不孕症治疗的有效方法正在被广泛应用。随着ART子代人数的增加,ART的安全性引起更多关注。多胎妊娠发生率的增加使ART子代伴有更多围生风险,但排除多胎妊娠后,ART单胎子代同自然妊娠子代比较仍具有稍高的早产率、低出生体质量率及先天畸形率等围生结局。其机制目前尚不明确,潜在的不孕背景、ART操作、促排卵可能是引起ART子代不良围生结局的原因。优生优育指导、必要的产前筛查及诊断有利于改善ART子代围生结局。综述ART子代围生结局研究进展,了解ART的安全性。     

辅助生殖技术出生儿童的生长发育

近二十余年来辅助生殖技术(ART)在世界范围内广泛开展,解决了许多夫妇的不孕问题.但这些通过ART出生的儿童与自然受孕出生儿童的生长发育是否存在明显差别引起了广泛的关注,对ART儿童不同年龄阶段的生长发育及常规体外受精-胚胎移植(IVF-ET)、胞浆内单精子注射(ICSI)、冻融胚胎移植技术等ART妊娠出生的儿童的发育状况进行论述.目前资料表明ART本身对儿童的生长发育无明显影响.     

辅助生殖技术与出生缺陷

随着辅助生殖技术的不断发展,已成为治疗不孕症的主要手段之一.近年来,辅助生殖技术与胎儿出生缺陷相关性研究众多,因其中存在诸多的问题,两者之间的关系尚有争议,但越来越多的证据表明,辅助生殖技术与出生缺陷发病风险二者之间正相关.胎儿出生缺陷发生的机制尚未阐明,可能与不孕夫妇的固有因素以及不孕症的相关治疗有关.对不孕夫妇如何正确选择辅助生殖技术、防治出生缺陷的研究进行综述.     

辅助生殖技术与出生缺陷

随着辅助生殖技术的不断发展,已成为治疗不孕症的主要手段之一。近年来,辅助生殖技术与胎儿出生缺陷相关性研究众多,因其中存在诸多的问题,两者之间的关系尚有争议,但越来越多的证据表明,辅助生殖技术与出生缺陷发病风险二者之间正相关。胎儿出生缺陷发生的机制尚未阐明,可能与不孕夫妇的固有因素以及不孕症的相关治疗有关。对不孕夫妇如何正确选择辅助生殖技术、防治出生缺陷的研究进行综述。     

辅助生殖技术出生婴儿性别比及出生缺陷相关影响因素分析

目的探讨影响辅助生殖技术(ART)出生婴儿性别比及出生缺陷发生率的相关因素。方法回顾性分析2012年1月-2016年7月在河北省计划生育科学技术研究院生殖医学中心接受ART治疗并成功分娩的患者396例,出生婴儿504例。分析年龄、受精方式、精液来源、胚胎来源和分娩胎数等因素对于出生婴儿性别及出生缺陷的影响。结果 (1)504例出生婴儿中,男婴270例,女婴234例,性别比为115∶100,不同因素对出生婴儿性别比均无显著影响(P0.05)。(2)出生缺陷儿9例,出生缺陷率为1.79%,其中年龄20~24岁组出生缺陷率显著高于25~29岁组(P0.05),冷冻胚胎移植组出生缺陷率低于新鲜胚胎移植组(P0.05),双胎分娩组出生缺陷率显著高于单胎分娩组(P0.05)。(3)双胎出生缺陷儿占出生缺陷儿总数的88.89%(8/9),补救-卵胞浆内单精子注射(R-ICSI)20~24岁组较25~29岁组双胎出生缺陷率高(P0.05),冷冻胚胎移植组双胎出生缺陷率显著低于新鲜胚胎移植组(P0.05)。结论患者年龄、受精方式、精液来源、胚胎来源和分娩胎数等因素不影响ART出生婴儿性别比,冷冻胚胎移植和单胎妊娠均能一定程度上降低出生缺陷风险。     

辅助生殖技术子代的围生结局研究进展

辅助生殖技术（assisted reproductive technology,ART）作为不孕症治疗的有效方法正在被广泛应用。随着ART子代人数的增加,ART的安全性引起更多关注。多胎妊娠发生率的增加使ART子代伴有更多围生风险,但排除多胎妊娠后,ART单胎子代同自然妊娠子代比较仍具有稍高的早产率、低出生体质量率及先天畸形率等围生结局。其机制目前尚不明确,潜在的不孕背景、ART操作、促排卵可能是引起ART子代不良围生结局的原因。优生优育指导、必要的产前筛查及诊断有利于改善ART子代围生结局。综述ART子代围生结局研究进展,了解ART的安全性。     

A Population-Based Study of Maternal and Perinatal Outcomes Associated with Assisted Reproductive Technology in Massachusetts

Objective: To assess associations between assisted reproductive technology (ART) and adverse maternal and infant outcomes, with an emphasis on singletons. Methods: We linked data from the US ART surveillance system with Massachusetts live birth-infant death records data for resident births in 1997–1998 and compared births conceived with ART (N = 3316) with births not conceived with ART or infertility medications (N = 157,066) on: maternal chronic conditions, pregnancy complications, labor and delivery complications, and perinatal and infant outcomes. Results: Overall, ART was strongly associated with numerous adverse outcomes. The magnitude was reduced for several outcomes when analyses were limited to singletons. After further exclusion of maternal subsets with rare ART births (maternal age <20; education <high school; unmarried, no or public health insurance; no or third trimester prenatal care initiation), and matching ART and non-ART singletons on birth hospital, birth month and year, maternal age, parity, and race/ethnicity, ART remained associated with pre-existing diabetes (Relative Risk [RR] = 2.2 95% confidence interval 1.02–4.9), incompetent cervix (RR = 6.0, [2.3–15.4]), pregnancy-induced hypertension (RR = 1.5, [1.04–2.2]), uterine bleeding (RR = 3.2, [1.5–6.8]), placental abruption (RR = 3.8 [1.6–9.4]), placenta previa (RR = 3.8, [1.6–9.4]), preterm delivery (RR = 2.4, [1.8–3.0]), very preterm delivery (RR = 2.5, [1.2–5.2]), low birth weight (RR = 2.1, [1.5–2.9]), and infant not discharged home (RR = 1.8, [1.2–2.6]). Conclusions: Women who conceive with ART are more likely than women who do not to enter pregnancy with a chronic condition and develop complications during pregnancy and labor and delivery. Additionally, infants born after ART are at increased risk for adverse health outcomes. The mechanisms underlying these associations require further study. The member clinics of MCARTER are listed in the Acknowledgments. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.     

The Association Between Major Birth Defects and Preterm Birth

Objective To evaluate the association between preterm birth and major birth defects by maternal and infant characteristics and specific types of birth defects. Study Design We pooled data for 1995–2000 from 13 states with population-based birth defects surveillance systems, representing about 30% of all U.S. births. Analyses were limited to singleton, live births from 24–44 weeks gestational age. Results Overall, birth defects were more than twice as common among preterm births (24–36 weeks) compared with term births (37–41 weeks gestation) (prevalence ratio [PR] = 2.65, 95% confidence interval [CI] 2.62–2.68), and approximately 8% of preterm births had a birth defect. Birth defects were over five times more likely among very preterm births (24–31 weeks gestation) compared with term births (PR = 5.25, 95% CI 5.15–5.35), with about 16% of very preterm births having a birth defect. Defects most strongly associated with very preterm birth included central nervous system defects (PR = 16.23, 95% CI 15.49–17.00) and cardiovascular defects (PR = 9.29, 95% CI 9.03–9.56). Conclusions Birth defects contribute to the occurrence of preterm birth. Research to identify shared causal pathways and risk factors could suggest appropriate interventions to reduce both preterm birth and birth defects.     

中国国家出生队列建设背景和设计简介

随着生活行为方式、自然和社会环境的急剧变化,育龄人口生殖健康状况持续下降,快速增加的由辅助生殖技术（ART）孕育的子代的远期健康状况亟待评估。因此,妇幼保健和生殖健康相关研究关注的重点亟需从妊娠期、围产期的死亡和严重疾病表型逐渐向全生命周期和全疾病谱拓展。为了满足这样的研究需求,在我国12个省（自治区、直辖市）启动了中...     

中国国家出生队列研究的理念与实践

出生队列研究在探讨生命早期暴露对子代远期健康的影响中发挥重要作用。随着育龄人口生殖健康问题的凸显, 辅助生殖技术被广泛应用于临床。而关于辅助生殖技术对母婴健康的远期影响尚未得到充分研究。2016年, 以家庭为单位, 同步招募辅助受孕家庭和自然受孕家庭的多中心前瞻性的中国国家出生队列(CNBC)研究正式启动。截至2021年6月30日, 已累计在全国招募7.2万个家庭, 包括辅助生殖家庭3.9万个和自然妊娠家庭3.3万个, 本队列以面对面随访的形式在辅助生殖治疗前、胚胎移植、孕早期、孕中期、孕晚期及分娩时以及婴儿出生后42 d、6个月、1岁、3岁时采集数据信息和生物样本。其主要目标为评估使用辅助生殖技术后诞生子代的发育和健康状况, 发现与不良出生结局和儿童期疾病相关的危险因素, 为提升出生人口质量的策略制定提供科学依据。本文将对国家出生队列的建设概况和研究进展做简要介绍。     

北京市大气污染对不良妊娠结局影响的病例对照研究

目的 定量分析和评价北京市大气污染对新生儿早产、低出生体重及出生缺陷等不良妊娠结局的影响.方法 收集北京市海淀区妇幼保健院2007年7月-2009年7月分娩个案资料、同期北京市大气污染物二氧化硫(SO2)、二氧化氮(NO2)、可吸入颗粒物(PM10)及气象因素资料.采用多因素Logistic回归模型调整气象因素和妊娠期妇女个体信息的基础上,研究北京市大气污染物对不良妊娠结局的影响.结果 控制气象因素、孕妇分娩次数、年龄、胎儿性别、不良接触史等因素后,妊娠后第1个月SO2浓度每升高100μg/m3,对低出生体重的影响的OR值为1.50(95％CI:1.09～2.05);妊娠后前3个月、分娩前第1个月SO2浓度每升高100 μg/m3,对早产影响的OR值分别为1.50 (95％CI:1.04～2.18)和1.79(95％CI:1.30～2.46);分娩前第2个月PM10浓度每升高100 μg/m3,对早产的影响的OR值为1.45(95％CI:1.15～1.84);妊娠后3～8周内,NO2浓度每升高100 μg/m3,对出生缺陷的影响的OR值为2.85(95％CI:1.08～7.50).结论 本次调查的北京市妊娠期妇女在妊娠后期的大气PM10暴露浓度、妊娠早期的大气SO2暴露浓度与早产的发生存在统计学关联;妊娠3～8周时NO2暴露浓度与出生缺陷的发生存在统计学关联.     

中国国家出生队列研究调查对象的基线特征分析

目的 探讨生命早期环境因素、遗传因素和遗传与环境交互作用对子代近期和远期健康的影响以及系统评价和比较辅助生殖受孕和自然受孕人群的妊娠结局和子代健康相关结局。方法 中国国家出生队列（CNBC）研究是一项覆盖辅助生殖受孕家庭和自然受孕家庭的多中心前瞻性出生队列研究。2016年,CNBC项目陆续在我国12个省（自治区、直辖市）的24所医院启动,以家庭为单位纳入研究对象,并在辅助生殖治疗前、胚胎移植、孕早期、孕中期、孕晚期及分娩时以及出生后第42天、6个月、12个月、36个月多个时点采集数据信息和生物样本。结果 截至2020年6月,CNBC共纳入27 044个辅助生殖受孕家庭,29 589个自然受孕家庭,CNBC的研究人群中绝大部分为城市居民。在辅助生殖受孕家庭中,男女双方分别有65.5%和63.7%为大学及以上文化程度,年龄为（33.83±5.52）和（32.38±4.67）岁;女方83.2%为初产妇,吸烟率为0.8%,饮酒率为2.1%。在自然受孕家庭中,男女双方分别有81.5%和86.5%为大学及以上文化程度,年龄为（32.06±5.09）和（30.40±4.27）岁,女方67.2%为初产妇,吸烟率为0.1%,饮酒率为2.2%。不同地区的辅助生殖受孕家庭和自然受孕家庭的基线特征均有差异。结论 CNBC的建立将为研究生命早期遗传、环境因素、遗传-环境交互作用以及辅助生殖技术治疗相关因素对出生后子代健康的影响提供了重要资源。     

The Risk of Having a Low Birth Weight or Preterm Infant among Cosmetologists in New York State

Objectives This study sought to determine if female licensed cosmetologists have a higher risk of low birth weight, small-for-gestational-age, and preterm delivery compared to two different comparison groups. Methods This retrospective cohort study matched 15,003 licensed cosmetologists and a comparison group of 4,246 licensed realtors to birth records in New York State from 1997 to 2003. A second comparison group from the general population of New York State (n = 12,171) was frequency matched to cosmetologists on child’s year of birth, mother’s ethnicity and mother’s education. Results A positive association was found for low birth weight when comparing cosmetologists to realtors (adjusted odds ratio 1.36 (95% confidence interval: 1.09, 1.70)). Associations were stronger in non-whites than in whites in each birth weight comparison. Associations observed for small-for-gestational-age or preterm births with either comparison group were close to the null or had wide confidence intervals that included the null. Conclusions We observed a slightly increased risk for having a child born low birth weight among cosmetologists compared to another group of licensed professionals. The risk was greater among non-white races in each comparison.     

The Influence of Maternal Mobility on Birth Outcomes of non-Hispanic Blacks

Background We investigated whether the “healthy migrant” effect is applicable to an internally mobile U.S.-born population, that is, whether infants born to women that moved within the United States had better birth outcomes compared to those infants whose mothers did not move. Methods This study used 1995–2001 National Center for Health Statistics live birth/infant death cohort files of singleton infants born in the U.S. to non-Hispanic Black women. Results Infants born to women who moved had significantly lower risks of low birth weight, preterm birth, and SGA compared to the non-mobile group. Conclusions There is evidence to support the healthy migrant effect in an internally migrant Black population. The findings of this study suggest infants of non-Hispanic Black mothers who were born in one state and moved prior to delivery had more positive birth outcomes when compared to those infants of women who did not move prior to delivery. Greg R. Alexander is deceased.     

空气污染对早产和低出生体重影响的流行病学研究现况

空气污染对不良妊娠结局的影响研究日益被国内外的专家所关注,空气污染物与早产和低出生体重的研究有待进一步开展。该文就近年来有关空气污染物(可吸入颗粒物、细颗粒物、CO、NO2、SO2等)对早产和低出生体重影响的流行病学研究进行了综述,为控制空气污染和减少不良妊娠结局的发生以及进一步探索其可能的机制提供有益的参考。