单胎妊娠中辅助生殖技术对妊娠期糖尿病发病影响的系统评价与Meta分析

Effects of assisted reproductive technology in single pregnancy on the incidence of gestational diabetes:a systematic review and meta-analysis

目的系统评价在单胎妊娠中采用辅助生殖技术(assisted reproductive technology,ART)孕产妇与自然妊娠孕产妇在妊娠期糖尿病(gestational diabetes mellitus,GDM)发病率的差异。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、CNKI、WanFang Data、VIP和CBM数据库,搜集ART(单胎)与GDM发病率相关的队列研究,检索时限均从建库至2019年6月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入16个队列研究,包括2 017 573例单胎妊娠孕妇。Meta分析结果显示:与自然妊娠组相比,辅助生殖组GDM的发病率更高[RR=1.54,95%CI(1.30,1.83),P<0.000 01]。按照地区进行分组,东亚地区和非东亚地区的辅助生殖组的GDM发病率均高于自然妊娠组[东亚:RR=1.55,95%CI(1.26,1.92),P<0.000 01;非东亚:RR=1.49,95%CI(1.18,1.89),P<0.000 01]。结论当前研究证据显示,单胎妊娠的ART助孕与自然妊娠受孕相比,GDM的发病率可能增加。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the effects of assisted reproductive technology in single pregnancy on the incidence of gestational diabetes.Methods PubMed,EMbase,The Cochrane Library,Web of Science,CNKI,WanFang Data,VIP and CBM databases were electronically searched to collect cohort studies on the correlation between assisted reproductive technology(ART)and gestational diabetes mellitus(GDM)incidence in single pregnancy from inception to June 2019.Two reviewers independently screened literature,extracted data and assessed risk of bias of included studies.Meta-analysis was then performed by using RevMan 5.3 software.Results A total of 16 cohort studies involving 2017573 cases of single pregnancy were included.The results of meta-analysis showed that compared with the natural pregnancy group,the incidence of GDM was higher in the ART group(RR=1.54,95%CI 1.30 to 1.83,P<0.00001).In East Asia and Non-East Asia,the incidence of GDM in the ART group was higher than that in the natural pregnancy group(East Asia:RR=1.55,95%CI 1.26 to 1.92,P<0.00001;Non-East Asia:RR=1.49,95%CI 1.18 to 1.89.P<0.0001).Conclusions Current evidence shows that the incidence of GDM may increase in single pregnancy with ART compared with natural pregnancy.Due to limited quantity and quality of the included studies,more high quality studies are required to verify above conclusions.