辅助生殖技术单胎妊娠结局分析

Analysis of pregnancy outcomes of single pregnancy with assisted reproductive technology

目的:研究辅助生殖技术(ART)与自然受孕两种不同受孕方式单胎妊娠的妊娠结局。方法:回顾分析2009年1月1日至2017年12月31日在广州医科大学附属第三医院住院分娩的妊娠≥20周的单胎妊娠病例资料。按受孕方法分为ART组及自然妊娠组,分析两组母儿结局,再按是否为高龄妊娠,比较ART组及自然妊娠组的母儿结局。结果:ART组孕妇的平均年龄、初产妇、定期产检、非足月胎膜早破(PPROM)、羊水量异常、子痫前期、妊娠期高血压、妊娠合并血小板减少症、妊娠期糖尿病、糖尿病合并妊娠、前置胎盘、胎盘植入/粘连、产后出血、剖宫产分娩、产钳/吸引产助产、人工剥离胎盘、药物/机械性引产、流产、胎儿窘迫及胎儿为男性发生率均高于自然妊娠组,ART组的住院天数更长,分娩孕周更低,转诊重症监护病房(ICU)、急性器官衰竭发生风险较低,ART组围产儿平均体重高于自然受孕组。高龄妊娠孕妇中,ART组的妊娠期糖尿病、剖宫产分娩发生风险增加。非高龄妊娠孕妇中,ART组子痫前期、妊娠期高血压、妊娠期糖尿病、糖尿病合并妊娠、流产、PROM、羊水量异常、前置胎盘、胎盘植入/粘连、产后出血、胎儿窘迫、人工剥离胎盘、药物/机械性引产发生风险增加。ART组较自然妊娠组钳产/吸引产风险均增加,产妇转诊ICU及非规律产检发生风险均降低,差异均有统计学意义(均P<0.05)。结论:ART受孕单胎妊娠并发症及新生儿不良结局发生率高于自然妊娠组孕妇,但其更注重孕期产检;在非高龄妊娠孕妇中,ART组母儿不良结局风险增加,而高龄妊娠孕妇中,ART组母儿不良结局风险增加不明显。

Objective:To study the pregnancy outcomes of single pregnancy with assisted reproductive technology(ART)and spontaneous conception(SC)in single pregnancy.Methods:A retrospective analysis was performed on the singleton pregnancies with gestation≥20 weeks who were admitted to the third Affiliated Hospital of Guangzhou Medical University during January 1st 2009 and 31st December 2017.All the eligible patients were divided into ART group and SC group.The maternal and perinatal outcomes of the two groups were analyzed.Then the maternal and perinatal outcomes in both groups were compared according to advanced maternal age(AMA).Results:The mean age of pregnant women in the ART group was significantly higher than that in the SC group.In the ART group,the risk of primiparas,regular prenatal care,preterm premature rupture of membranes(PPROM),abnormal amniotic fluid,preeclampsia,gestational hypertension,pregnancy with thrombocytopenia,gestational diabetes,diabetes mellitus with pregnancy,placenta previa,placenta increta/adhesion,forceps,postpartum hemorrhage,cesarean delivery,forceps/suction delivery,artificial detachment of placenta and drug/mechanical induced labor,abortion,fetal distress and male fetuses were higher than that in SC group.In ART group,hospitalization days were longer,gestational age were lower,and the perinatal weight was higher.Among the advanced maternal age women,the risk of gestational diabetes and cesarean section was increased in the ART group.Among non-advanced maternal age women,the ART group had an increased risk of preeclampsia,gestational hypertension,gestational diabetes,diabetes mellitus with pregnancy,abortion,PROM,abnormal amniotic fluid,placenta previa,placenta intreta/adhesion,postpartum hemorrhage,fetal distress,artificial detachment of placenta,and drug/mechanical induction.Among the two groups of pregnant women,the risk of forceps/suction delivery in the ART group was increased compared with that in the SC group,and the risk of referral to ICU and irregular prenatal care was reduced,with statistically significant differences(all P<0.05).Conclusion:The incidence of complications and neonatal adverse outcomes in single pregnancy with ART is higher than that in SC pregnancy.In advanced maternal age women,the risk of maternal and neonatal adverse outcomes increased in ART group,while in advanced maternal age women,the risk of maternal and neonatal adverse outcomes increased not significantly in ART group.