体外受精-胚胎移植出生2岁幼儿生长发育的研究

Developmental outcome at 2 years of age for children born after in vitro fertilization

目的通过对常规体外受精(IVF)和卵胞浆内单精子注射(ICSI)后出生2岁幼儿体格检查和精神运动发育测定,了解IVF后出生幼儿生长发育和健康情况,以评价IVF、ICSI的安全性。方法2000年1月至2002年12月在本中心进行IVF和ICSI后出生各50名2岁幼儿为研究对象,本院同期自然妊娠出生2岁的50个幼儿作为对照组。对三组2岁幼儿进行体重、身高、头围、胸围4项指标测量及全身体格检查,采用"Bayley婴儿发育量表"测定精神运动发育。比较三组体格、智力和运动发育的差异。结果(1)三组2岁幼儿的身高、体重、头围、胸围等体格发育指标和Bayley运动发育指数(PDI),无显著性差异(P>0.05);ICSI组智力发育指数(MDI)稍低于IVF和对照组,但无显著性差异(P>0.05)。(2)6%IC-SI组幼儿智力发育迟缓(MDI<70)高于IVF组(2%)和对照组(0%),但无显著性差异(P>0.05);分别有2%、4%及2%运动发育迟缓(PDI<70),组间无显著性差异(P>0.05)。各组的单胎与双胎比较,MDI有显著性差异(P<0.05);PDI无显著性差异(P>0.05)。(3)对可能影响精神和运动发育的因素进行多元逐步回归分析,显示MDI与窒息、母亲年龄和胎数呈负相关,与母亲文化程度呈正相关;PDI与窒息呈负相关。结论IVFI、CSI后妊娠不影响2岁幼儿体格发育及运动发育;ICSIMDI及智力发育迟缓率稍低于IVF和对照组,虽无显著性差异,但应予重视。双胎MDI都显著低于单胎,因此限制IVF-ET的胚胎移植数目,减少医源性多胎妊娠至关重要。

Objective： To assess somatic,psychomotor and intellectual development of children born after in vitro fertilization（IVF）.Methods： A prospective study involved 100 two-year-old children born after IVF and intracytoplasmic sperm injection（ICSI） from Jan 2000 to Dec 2002.They were divided into IVF and ICSI groups respectively,with 50 two-year-old children born after naturally conceived as controls.Weight,length,head and bosom circumferences were measured in all two-year-old children.The mental developmental index（MDI） or psychomotor developmental index（PDI） was assessed by Bayley Scales of Infant Development（BSID）.The fetal psychomotor and intellectual development of the three groups were compared.Results： No significant differences were observed at weight,length,head and bosom circumferences,MDI and PDI（P〉0.05） between IVF,ICSI and control groups.MDI of ICSI group was lower than that of IVF group and control group,but no significant difference was found.Mental retardation rates（MDI〈70） were 2%,6%,0% in IVF,ICSI and control group respectively.Psychomotor delayed development rates（PDI〈70） were 2%,4%,2% in IVF,ICSI and control group respectively.No significant differences were found among three groups（P〉0.05）.MDI but not PDI was significantly different between twins and singletons.Stepwise regression analysis showed that MDI had a significantly positive correlation with the asphyxia,mother＇s educational background and age,and PDI had a significantly positive correlation with the asphyxia.Conclusions：Two-year-old children＇s psychomotor development has not been affected by the technique of IVF and ICSI.MDI and mental retardation rate of ICSI group were slightly higher than those of IVF and control groups,which deserves attention.The possible risk factors affected intellectual development were asphyxia of fetus,multiply pregnancy and mother＇s education condition etc.