辅助生殖技术对新生儿不良出生结局影响的回顾性队列研究

Effect of assisted reproductive technology on neonatal adverse birth outcome:a retrospective cohort study

目的探讨辅助生殖技术(ART)对不良出生结局的影响。方法采用1∶1匹配的回顾性队列研究方法,收集2012年3月-2016年10月在山西医科大学第一医院产科住院分娩同时行ART助孕生殖的孕产妇247例作为暴露组,同期自然受孕的孕产妇247例作为对照组,采用面对面问卷调查的方法由经培训合格的调查员进行,同时查阅相关病历信息,收集孕产妇一般人口学特征、健康状况、产前检查情况、产前生活习惯、怀孕前慢性疾病史、慢性病家族史及既往孕产史。比较两组新生儿不良出生结局。结果暴露组孕产妇多胎妊娠、初产妇、妊娠期高血压疾病、妊娠期糖尿病、妊娠期每周运动时间、人工流产史及宫外孕史情况均高于对照组孕产妇,差异均有统计学意义(P<0.05)。暴露组发生低出生体质量和死胎的风险是对照组的2.41倍(RR=2.41,95%CI:1.353~4.328)和6.614倍(RR=6.614,95%CI:1.810~53.990),其中单胎妊娠经ART助孕治疗后发生早产和低出生体质量的风险是对照组的1.431倍(RR=1.431,95%CI:1.020~2.842)和1.440倍(RR=1.440,95%CI:1.216~2.936)。结论暴露组新生儿低出生体质量及死胎的发生风险增高,剔除双胎及多胎的研究对象后,在单胎孕产妇中ART助孕使早产及新生儿低出生体质量的发生风险明显增高。

Objective To explore the effect of assisted reproductive technology(ART)on neonatal adverse birth outcome.Methods A 1∶1 matched retrospective cohort study was carried out to collect 247 pregnant women treated by ART in Department of Obstetrics in Shanxi Medical University from March 2012 to October 2016 as exposure group,247 pregnant women conceived naturally were collected as control group.A face-to-face questionnaire survey was conducted,the related medical records were collected,including general demographic characteristics,physical condition,prenatal examination,prenatal living habits,chronic disease history before pregnancy,family history of chronic disease,and pregnancy history.Neonatal adverse birth outcomes in the two groups were compared.Results Multiple pregnancy,primipara,hypertensive disorder complicating pregnancy,gestational diabetes mellitus,weekly exercise time during pregnancy.History of artificial abortion,and ectopic pregnancy in exposure group were statistically significantly higher than those in control group(P<0.05).The risks of low birth weight and stillbirth in exposure group were 1.41 times and 5.614 times more than those in control group,respectively(RR=2.41,95%CI:1.353-4.328;RR=6.614,95%CI:1.810-53.990).Among the cases of single pregnancy,the risks of premature delivery and low birth weight after ART in exposure group were 0.431 times and 0.440 times more than those in control group,respectively(RR=1.431,95%CI:1.020-2.842;RR=1.440,95%CI:1.216-2.936).Conclusion The risks of low birth weight and stillbirth in exposure group increase,after excluding twin pregnancy and multiple pregnancy,the risks of premature delivery and low birth weight after ART in exposure group increase significantly among the cases of single pregnancy.