不同辅助生殖技术妊娠分娩的1540例新生儿出生缺陷分析

Analysis of 1540 neonates with birth defects related to different assisted reproductive technique

目的探讨不同辅助生殖技术妊娠分娩的新生儿出生缺陷的发生情况及影响因素。方法对1998年10月至2006年12月在郑州大学第一附属医院生殖医学中心接受体外受精（IVF）助孕[IVF、卵母细胞胞质内单精子注射（ICSI）、冻融胚胎移植（Thaw—ET）]妊娠的孕妇分娩的1271例新生儿（体外受精组）及同期接受人工授精妊娠的孕妇所分娩的269例新生儿（人工授精组）的临床资料进行分析，比较两组及不同辅助生殖技术后出生的新生儿情况、出生缺陷及出生缺陷受累系统。结果体外受精组中，IVF、ICSI、Thaw—ET后出生的低体重（LBW）儿分别为20．0％（134／671）、22．4％（92／410）、18．9％（36／190），也均高于人工授精组的11．5％（31／269），差异有统计学意义（P〈0．05）；多胎妊娠率分别为23．8％（160／671）、25．4％（104／410）、21．1％（40／190），均高于人工授精组的10．0％（27／269），差异也有统计学意义（P〈0．05）。ICSI后巨大儿发生率为3．9％（16／410），显著低于人工授精组的8．2％（22／269），两者比较，差异也有统计学意义（P〈0．05）；两组新生儿各系统出生缺陷比较，差异无统计学意义（P〉0．05）。结论不同体外受精助孕后多胎率明显升高，由此造成的相关风险也随之增加，但新生儿的出生缺陷并没有明显增加；减少多胎妊娠是保护出生新生儿健康的关键。

Objective To investigate the incidence of and clinical factors influencing neonatal birth defects from different assisted reproductive technology. Methods Between October 1998 and December 2006,1271 newborns from mothers treated by in vitro fertilization techniques [ including in vitro fertilization （IVF）, intracytoplasmic sperm injection （ICSI） and thaw embryo transfer （Thaw-ET）] matched with 269 newborns from mothers treated by artificial insemination were enrolled in Reproductive Medicine Center in First Hospital Affiliated to Zhengzhou University. Their medical information was analyzed retrospectively to compared neonatal characteristics, the incidence of birth defect and anomalous organs involved between in vitro fertilization group and artificial insemination group. Results In group of in vitro fertilization, those newborns with low birth weight from IVF, ICSI and Thaw-ET were 20. 0% （ 134/671 ）, 22.4% （92/410）, 18.9% （36/190）respectively, which were more than 11.5% （31/269） cases in group of artifical senaination with statistical significance （P 〈 0.05 ）. The rates of multiple pregnancy of 23.8% （160/671 ）, 25.4% （104/410） ,21.1% （40/190） in subgroup of IVF, ICSI and Thaw-ET were significantly higher than lO. 0% （27/269） in group of artifical insemination（P 〈 O. 05）. The rate of macrosomia in group of in vitro fertilization was significantly lower than that of artificial insemination group （3.9% vs 8.2%, P 〈 0. 05 ）. However, the incidence of birth defect involved in various organs did not show significant difference between two groups （P 〉 0. 05）. Conclusions The incidence of multiple pregnancy demonstrated obviously increasing trends born with various In Vitro Fertilization techniques, which pave the way to high risk pregnancy. However,the incidence of newborn birth defect was not increased significantly. Thus, to lower occurrence of multiple pregnancy was the key approach to obtain neonates health.