2304例辅助受孕儿新生情况对照研究
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摘要
目的了解辅助受孕儿与自然受孕儿新生情况之间的差异。方法采用前瞻性对照研究方法,观察组为辅助受孕儿,对照组为自然受孕儿,均自母亲孕28周入组登记,由指定专业人员定期随访收集相关资料。结果观察组新生儿中双胎儿、早产、低出生体重、新生儿期入住NICU、剖宫产等发生率明显高于对照组新生儿,差异均有统计学意义(P<0. 05);但两组间出生缺陷的发生率差异无统计学意义(P>0. 05)。在剔除了双胎儿,仅比较两组中的单胎儿时两组间差异消失,但观察组剖宫产发生率仍明显高于对照组。另对3种不同辅助受孕方式产生的子代新生儿进行比较,各组间差异无统计学意义(P>0. 05)。结论辅助受孕技术本身对子代的新生情况无明显影响,高发的双胎及多胎妊娠率是引起辅助受孕子代有更差的新生情况的主要原因。因此,限制胚胎移植数量、进行单胚胎移植可能是改善辅助受孕子代新生情况的最有效方法。
Objective To survey the difference of neonatal outcomes of infants conceived by assisted reproductive technology and infants conceived naturally. Methods A prospective case-control study was performed among infants conceived by assisted reproductive technology( observation group) and infants conceived naturally( control group). The mothers of these infants were 28 gestational weeks at registration. The related data were collected by designated professional regularly. Results The incidence rates of twin,preterm birth,low birth weight,admission to neonatal intensive care unit,and cesarean section in observation group were statistically significantly higher than those in contral group( P<0. 05),but there was no statistically significant difference in the incidence rate of birth defects between the two groups( P>0. 05). After excluding twin,the difference disappeared when comparing single fetuses between the two groups,but the rate of cesarean section in observation group was still more than that in control group. There was no statistically significant difference in neonatal outcome among the infants conceived by three different methods of assisted reproductive technology( P>0. 05). Conclusion Assisted reproductive technology has no significant impact on neonatal outcome,high incidence rates of twin pregnancy and multiple pregnancy are the main causes of poor neonatal outcome after assisted conception. Thus,limiting the number of embryos transferred and conducting single embryo transfer may be the effective methods to improve neonatal outcome after assisted conception.
Objective To survey the difference of neonatal outcomes of infants conceived by assisted reproductive technology and infants conceived naturally. Methods A prospective case-control study was performed among infants conceived by assisted reproductive technology( observation group) and infants conceived naturally( control group). The mothers of these infants were 28 gestational weeks at registration. The related data were collected by designated professional regularly. Results The incidence rates of twin,preterm birth,low birth weight,admission to neonatal intensive care unit,and cesarean section in observation group were statistically significantly higher than those in contral group( P<0. 05),but there was no statistically significant difference in the incidence rate of birth defects between the two groups( P>0. 05). After excluding twin,the difference disappeared when comparing single fetuses between the two groups,but the rate of cesarean section in observation group was still more than that in control group. There was no statistically significant difference in neonatal outcome among the infants conceived by three different methods of assisted reproductive technology( P>0. 05). Conclusion Assisted reproductive technology has no significant impact on neonatal outcome,high incidence rates of twin pregnancy and multiple pregnancy are the main causes of poor neonatal outcome after assisted conception. Thus,limiting the number of embryos transferred and conducting single embryo transfer may be the effective methods to improve neonatal outcome after assisted conception.
引文
[1]Wisborg K,Ingerslev HJ,Henriksen TB.In vitro fertilization and preterm delivery,low birth weight,and admission to the neonatal intensive care unit:a prospective follow-up study[J].Fertil Steril,2010,94(6):2102-2106.
[2]Schieve LA,Meikle SF,Feree C,et al.Low and very low birth weight in infants conceived with use of assisted reproductive technology[J].N Engl J Med,2002,346(10):731-736.
[3]Wisborg K,Ingerslev HJ,Henriksen TB.IVF and stillbirth:a prospective follow-up study[J].Hum Reprod,2010,25:1312-1316.
[4]Gunby J,Bissonnette F,Librach C,et al.Assisted reproductive technologies(ART)in Canada:2006 results from the Canadian ART Register[J].Fertil Steril,2010,93(7):2189-2201.
[5]Sunderam S,Chang J,Flowers L,et al.Assisted reproductive technology surveillance-United States,2006[J].Morb Mortal Wkly Rep,2009,58(1):1-25.
[6]Mouzon J,Goossens V,Bhattacharya S,et al.Assisted reproductive technology in Europe,2006:results generated from European registers by ESHRE[J].Hum Reprod,2010,25(8):1851-1862.
[7]Henningsen AK,Pinborg A,Lidegaard,et al.Perinatal outcome of singleton siblings born after assisted reproductive technology and spontaneous conception:Danish national sibling-cohort study[J].Fertil Steril,2011,95(3):959-963.
[8]Sazonova A,Kllen K,Thurin-Kjellberg A,et al.Obstetric outcome after in vitro fertilization with single or double embryo transfer[J].Hum Reprod,2011,26(2):442-450.
[9]Romundstad LB,Romundstad PR,Sunde A,et al.Effects of technology or maternal factors on perinatal outcome after assisted fertilization:a population-based cohort study[J].Iancet,2008,372(9640):737-743.
[10]Olson CK,Keppler-Noreuil KM,Romitti PA.In vitro fertilization is associated with an increase in major birth defects[J].Fertil Steril,2005,84(5):1308-1315.
[11]Reefhuis J,Honeinl MA,Schievel LA,et al.Assisted reproductive technologhies and major structural birth defects in the United States[J].Hum Reprod,2009,24(2):360-366.
[12]Wen J,Jiang J,Ding C,et al.Birth defects in children conceived by in vitro fertilization and intracytoplasmic sperm injection:a meta-analysis[J].Fertil Steril,2012,97(6):1331-1337.
[13]Yan J,Huang G,Sun Y,et al.Birth defects after assisted reroductive technologies in China:analysis of 15405 offspring in seven centers(2004 to 2008)[J].Fertil Steril,2011,95(1):458-460.
[14]Davies MJ,Moore VM,Willson KJ,et al.Reproductive technologies and the risk of birth defects[J].N Engl J Med,2012,366(19):1803-1813.
[15]Pinborg A,Loft A,Aaris Henningsen AK,et al.Infant outcome of957 singletons born after frozen embryo replacement:the Danish National Cohort Study 1995-2006[J].Fertil Steril,2010,94(4):1320-1327.
[16]Maheshwari A,Pandi S,Shetty A,et al.Obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of frozen thawed versus fresh embryos generated through in vitro fertilization treatment:a systematic review and meta-analysis[J].Fertil Steril,2012,98(2):368-377.
[17]Marino JL,Moore VM,Willson KJ.et al.Perinatal outcomes by mode of assisted conception and sub-fertility in an Australian data linkage cohort[J].PLoS One,2014;9(1):e80398.
[2]Schieve LA,Meikle SF,Feree C,et al.Low and very low birth weight in infants conceived with use of assisted reproductive technology[J].N Engl J Med,2002,346(10):731-736.
[3]Wisborg K,Ingerslev HJ,Henriksen TB.IVF and stillbirth:a prospective follow-up study[J].Hum Reprod,2010,25:1312-1316.
[4]Gunby J,Bissonnette F,Librach C,et al.Assisted reproductive technologies(ART)in Canada:2006 results from the Canadian ART Register[J].Fertil Steril,2010,93(7):2189-2201.
[5]Sunderam S,Chang J,Flowers L,et al.Assisted reproductive technology surveillance-United States,2006[J].Morb Mortal Wkly Rep,2009,58(1):1-25.
[6]Mouzon J,Goossens V,Bhattacharya S,et al.Assisted reproductive technology in Europe,2006:results generated from European registers by ESHRE[J].Hum Reprod,2010,25(8):1851-1862.
[7]Henningsen AK,Pinborg A,Lidegaard,et al.Perinatal outcome of singleton siblings born after assisted reproductive technology and spontaneous conception:Danish national sibling-cohort study[J].Fertil Steril,2011,95(3):959-963.
[8]Sazonova A,Kllen K,Thurin-Kjellberg A,et al.Obstetric outcome after in vitro fertilization with single or double embryo transfer[J].Hum Reprod,2011,26(2):442-450.
[9]Romundstad LB,Romundstad PR,Sunde A,et al.Effects of technology or maternal factors on perinatal outcome after assisted fertilization:a population-based cohort study[J].Iancet,2008,372(9640):737-743.
[10]Olson CK,Keppler-Noreuil KM,Romitti PA.In vitro fertilization is associated with an increase in major birth defects[J].Fertil Steril,2005,84(5):1308-1315.
[11]Reefhuis J,Honeinl MA,Schievel LA,et al.Assisted reproductive technologhies and major structural birth defects in the United States[J].Hum Reprod,2009,24(2):360-366.
[12]Wen J,Jiang J,Ding C,et al.Birth defects in children conceived by in vitro fertilization and intracytoplasmic sperm injection:a meta-analysis[J].Fertil Steril,2012,97(6):1331-1337.
[13]Yan J,Huang G,Sun Y,et al.Birth defects after assisted reroductive technologies in China:analysis of 15405 offspring in seven centers(2004 to 2008)[J].Fertil Steril,2011,95(1):458-460.
[14]Davies MJ,Moore VM,Willson KJ,et al.Reproductive technologies and the risk of birth defects[J].N Engl J Med,2012,366(19):1803-1813.
[15]Pinborg A,Loft A,Aaris Henningsen AK,et al.Infant outcome of957 singletons born after frozen embryo replacement:the Danish National Cohort Study 1995-2006[J].Fertil Steril,2010,94(4):1320-1327.
[16]Maheshwari A,Pandi S,Shetty A,et al.Obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of frozen thawed versus fresh embryos generated through in vitro fertilization treatment:a systematic review and meta-analysis[J].Fertil Steril,2012,98(2):368-377.
[17]Marino JL,Moore VM,Willson KJ.et al.Perinatal outcomes by mode of assisted conception and sub-fertility in an Australian data linkage cohort[J].PLoS One,2014;9(1):e80398.