短期不同水平PM_(2.5)暴露对早卵泡期降调节方案助孕患者妊娠结局的影响

Effects of short-term exposure to different levels of PM_(2.5) on pregnancy outcomes in patients with early-follicular phase downregulation scheme

目的探讨短期(30 d)不同水平PM_(2.5)暴露对早卵泡期降调节方案助孕患者的卵子质量、胚胎质量和妊娠结局的影响。方法采用回顾性队列研究的方法,选取2018年12月至2019年2月、2019年7~9月期间于湖北医药学院附属人民医院(十堰市人民医院)生殖医学中心进行辅助生殖助孕的早卵泡期降调节方案患者作为研究对象。根据PM_(2.5)的空气质量新标准,以115μg/m^(3)作为分界值,将患者分为高暴露组(n=94)和低暴露组(n=254)。患者从开始促排卵到验孕日这一时间段,活动区域均在十堰市市区,计算该时间段大气细颗粒物PM_(2.5)总量及日均量。比较两组间细颗粒物PM_(2.5)对卵子异常率、胚胎质量(可利用胚胎数、优质胚胎数、优质胚胎率、囊胚形成率)及妊娠结局(妊娠率、流产率、移植周期活产率、低出生体质量儿比例等)的影响。结果PM_(2.5)高暴露组的可利用胚胎数[(3.9±1.1)个]、优质胚胎数[(2.9±1.5)个]、优质胚胎率[35.5%(352/992)]与低暴露组[(4.3±1.2)个,P=0.005;(3.4±1.7)个,P=0.001;40.4%(792/1959),P=0.009]相比,均显著下降,而低出生体质量儿比例[21.4%(12/56)]显著高于低暴露组[5.26%(8/156),P<0.001],差异有统计学意义。结论短期PM_(2.5)高水平暴露对早卵泡期降调节方案的可利用胚胎数、优质胚胎数、优质胚胎率以及低出生体质量儿比例有明显负面影响。

ObjectiveTo study the effects of short-term(30 d)exposure to different levels of PM_(2.5) on oocyte quality,embryo quality and pregnancy outcomes in patients with early-follicular phase downregulation scheme.MethodsFrom December 2018 to February 2019,and from July to September 2019,348 patients with early-follicular phase downregulation scheme who underwent assisted reproduction and assisted pregnancy in the Reproductive Medicine Center,Renmin Hospital,Hubei University of Medicine were selected as the research objects in this retrospective cohort study.According to PM_(2.5) new air quality standard,with 115μg/m^(3) as the cut-off value,the patients were divided into high exposure group(n=94)and low exposure group(n=254).During the period from the start of ovulation induction to the pregnancy test day,the activity areas of the patients are in the urban area of Shiyan City.The PM_(2.5) of atmospheric fine particles during this period was calculated,including total amount and daily average amount.The effects of fine particulate matter PM_(2.5) on ovum abnormality rate,embryo quality(number of available embryos,number of high-quality embryos,high-quality embryo rate,and blastocyst formation rate)and pregnancy outcome(pregnancy rate,abortion rate,live birth rate and proportion of low birth weight infants)were compared between the two groups.Results Compared with the low exposure group,the number of available embryos(3.9±1.1 vs.4.3±1.2,P=0.005),the number of high-quality embryos(2.9±1.5 vs.3.4±1.7,P=0.001),high-quality embryo rate[35.5%(352/992)vs.40.4%(792/1959),P=0.009]and proportion of low birth weight infants[21.4%(12/56)vs.5.13%(8/156),P<0.001]in the high exposure group were significantly decreased,and there was no significant difference in other data.ConclusionShort-term exposure to high levels of PM_(2.5) had significant negative effects on the number of available embryos,the number of high-quality embryos,the rate of high-quality embryos and proportion of low birth weight infants in the early-follicular phase down-regulation scheme.