新鲜周期体外受精胚胎移植后子代单胎活产儿中小于胎龄儿的发生率及危险因素分析

目的 探究女性接受新鲜周期体外受精/卵母细胞内单精子注射（IVF/ICSI）-胚胎移植（ET）助孕后子代单胎活产儿中不同程度小于胎龄儿（SGA）的发生率及危险因素。方法 回顾性收集2014年4月-2020年12月于四川大学华西第二医院接受新鲜周期IVF/ICSI-ET助孕并分娩单胎活产儿的2262例患者的临床资料，根据子代出生体重在同性别、同胎龄新生儿中的百分位数将患者分为正常组（第10~第90百分位）、轻中度SGA组（第3~第10百分位）和重度SGA组（小于第3百分位）。比较不同程度SGA组与正常组患者病史及IVF/ICSI-ET相关临床资料的差异，采用多因素logistic回归筛选不同程度SGA的危险因素。结果 女性接受新鲜周期IVF/ICSI-ET助孕后分娩的单胎活产儿中SGA的发生率为9.9%，其中轻中度SGA的发生率为5.0%、重度SGA的发生率为4.9%。BMI<18.5 kg/m2、有自然流产史为子代发生轻中度SGA的危险因素（校正OR=4.54和1.91，95%CI=1.78~11.55和1.18~3.10）；有自然流产史、早产为子代发生重度SGA的危险因素（校正OR=2.80和2.22，95%CI=1.78~4.42和1.23~3.98）。有活产史为子代发生轻中度及重度SGA的保护因素。结论 接受新鲜周期IVF/ICSI-ET助孕的患者中，BMI<18.5 kg/m2、有自然流产史、早产者子代发生SGA的风险增加，临床工作中应予以关注

Incidence and risk factors of small for gestational age infants among living singletons after in vitro fertilization and fresh embryo transfer

Objective To explore the incidence and risk factors for different degrees of small for gestational age (SGA) infants among living singletons after in invitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) and fresh embryo transfer (ET) cycles. Methods A retrospective study involving 2262 singletons by IVF/ICSI and fresh ET from Apr. 2014 to Dec. 2020 were performed in West China Second University Hospital, Sichuan University. Participants were divided into mild-to-moderate SGA group and severe SGA group according to percentile of offspring birth weight among newborns of the same sex and gestational age. The clinical characteristics related to IVF/ICSI-ET were compared between different degrees of SGA groups and healthy group. Logistic regression analyses were performed to find IVF/ICSI-ET related risk factors of different degrees of SGA. Results The incidence of SGA among living singletons after IVF/ICSI and fresh ET treatment was 9.9%, among which the incidence of mild-to-moderate SGA was 5.0% and severe SGA was 4.9%. BMI <18.5 kg/m2 and history of spontaneous abortion were risk factors of mild-to-moderate SGA (adjusted OR=4.54 and 1.91, 95%CI=1.78~11.55 and 1.18~3.10); history of spontaneous abortion and premature birth were risk factors of severe SGA (adjusted OR=2.80 and 2.22,95%CI=1.78~4.42 and 1.23~3.98). The history of live birth was protective factor of SGA. Conclusion For patients concepted by IVF/ICSI and fresh ET, BMI<18.5 kg/m2, history of spontaneous abortion and premature birth were risk factors of SGA, which should be concerned in clinical works