辅助生殖技术助孕后子代出生缺陷风险:基于队列研究的Meta分析

目的评估辅助生殖技术(assisted reproductive technology,ART)助孕对子代出生缺陷的影响。方法检索从建库到2018年8月在PubMed、Embase、Cochrane图书馆、Sinomed、CNKI、万方、维普数据库中满足预先纳入标准的队列研究,使用I2统计和Q-检验评估研究之间的统计异质性,使用固定效应模型或随机效应模型估计总体组合的风险。结果本次最终纳入60项研究进行Meta分析,评估ART助孕后的子代730756名和自然受孕(spontaneously conceived,SC)的子代26185008名的出生缺陷风险。与SC子代相比,ART助孕后的子代出生缺陷风险高RR=1.42,95%CI(1.30-1.56)]。排除异质性大的1项研究后,余下59项研究在限定部分条件后,其出生缺陷风险的变化如下,泌尿生殖器畸形RR=1.49,95%CI(1.40-1.59)],单胎畸形RR=1.43,95%CI(1.30-1.58)],亚洲地区RR=1.52,95%CI(1.28-1.80)],基于临床的研究RR=1.36,95%CI(1.21-1.60)],小样本量的研究<500,RR=1.52,95%CI(1.35-1.72)],分层分析后,ART助孕后的子代出生缺陷风险高于SC子代。结论ART助孕子代出生缺陷风险高于SC组,因此在ART助孕后必须进行严格产前筛查,以避免严重畸形儿的出生。

Risk of birth defects in offspring after assisted reproductive technology:a Meta-analysis based on cohort studies

Objective To assess the impact of assisted reproductive technology(ART)on birth defects.Methods Retrieve the cohort studies that meet the pre-inclusion criteria in the PubMed,Embase,Cochrane Library,Sinomed,CNKI,Wanfang,and Vip databases from the establishment of the database to August 2018,I2 statistics and Q-tests were used to assess statistical heterogeneity between studies,and fixed-effects models or random-effects models were used to estimate the overall portfolio risk.Results 60 studies were finally included for a meta-analysis to assess the risk of birth defects in 730756 offspring after ART and 26185008 offspring of spontaneously conceived(SC).Compared with SC offspring,the offspring after ART had a higher risk of birth defectsRR=1.42,95%CI(1.30-1.56)].After excluding one study with large heterogeneity,the remaining 59 studies after a limited number of conditions,the risk of birth defects changes as follows:genitourinary malformationRR=1.49,95%CI(1.40-1.59)],singleton malformationRR=1.43,95%CI(1.30-1.58)],AsiaRR=1.52,95%CI(1.28-1.80)],clinical researchRR=1.36,95%CI(1.21-1.60)],in a study with a small sample size<500,RR=1.52,95%CI(1.35-1.72)],after stratified analysis,the risk of birth defects in ART offspring was higher than that in SC offspring.Conclusion The risk of birth defects of ART offspring is higher than that of SC group,so strict prenatal screening must be performed after ART to avoid birth of severe deformity.