新鲜周期与冻融周期胚胎移植助孕后胎儿宫内生长轨迹的比较分析

A comparison of fetal growth trajectory originated from frozen thawed embryo transfer and fresh embryo transfer

目的 探讨新鲜周期胚胎移植与冻融周期胚胎移植对胎儿宫内生长轨迹及新生儿结局的影响。方法 回顾性分析2019年1~6月在空军军医大学唐都医院生殖医学中心经体外受精-胚胎移植(in vitro fertilization and embryo transfer, IVF-ET)助孕并分娩的100例孕产妇的资料,分为冻融周期胚胎移植组(frozen-thawed embryo transfer, FET组,53例)和新鲜周期胚胎移植组(fresh embryo transfer, fET组,47例)。比较孕早期(孕12~14周)、孕中期(孕22~27周)、孕晚期(孕30~33周)、临产后(孕37周后)四个阶段两组胎儿头臀径、头围、腹围、胎盘厚度、脐动脉收缩末期峰值(S)与舒张末期峰值(D)比值(脐动脉S/D)的大小,比较出生后新生儿体重、身长、体质量指数、胎盘质量、新生儿体重/胎盘质量、性别比例。结果 孕早期,FET组比fET组胎儿的头臀径、胎盘厚度显著增大[(7.20±0.72)cm vs (6.79±1.28)cm,P<0.05;(1.79±0.31)cm vs (1.66±0.25)cm,P<0.05)];孕中期、孕晚期,两组胎儿头围、腹围、胎盘厚度、脐动脉S/D比较差异无统计学意义(P>0.05);临产后,与fET组相比,FET组胎儿头围增大,脐动脉S/D值减小[(33.24±1.08)cm vs (32.49±1.87)cm,P<0.01;(2.07±0.32)cm vs (2.21±0.33)cm,P<0.05)],腹围、胎盘厚度差异无统计学意义(P>0.05)。经FET出生的新生儿胎龄较小[(270.81±10.03)d vs (274.96±7.48)d,P<0.05],新生儿的体质量指数增加[(25.94±2.23)kg/m^(3)vs (24.75±2.13)kg/m^(3),P<0.05],两组新生儿出生体重、身长、胎盘质量、出生体重/胎盘质量、性别比例比较差异无统计学意义(P>0.05)。结论 经FET助孕后胎儿宫内生长及新生儿的生长指标总体上优于新鲜胚胎移植。

Objective To investigate the effects of fresh cycle embryo transfer and frozen-thawed cycle embryo transfer on fetal growth trajectory and neonatal outcomes.Methods The data of 100 pregnant women who were assisted by in vitro fertilization and embryo transfer(IVF-ET) in Reproductive Medicine Center of Tangdu Hospital of Air Force Military Medical University from January to June 2019 were retrospectively analyzed.They were divided into frozen-thawed embryo transfer(FET) group(n=53) and fresh embryo transfer(fET) group(n=47).The head and hip diameter, head circumference, abdominal circumference, placental thickness, and the ratio of umbilical artery S/D(umbilical artery S/D) were compared between the two groups at the first trimester(12~14 weeks),second trimester(22~27 weeks),third trimester(30~33 weeks) and postpartum stages(after 37 weeks).Postnatal neonatal weight, length, body mass index, placental mass, neonatal weight/placental mass, and sex ratio were compared.Results During the first trimester, fetal head and hip diameters and placental thickness were significantly larger in the FET group than in the fET group [(7.20±0.72)cm vs(6.79±1.28)cm, P<0.05;(1.79±0.31)cm vs(1.66±0.25)cm, P<0.05)];There were no significant differences in head circumference, abdominal circumference, placental thickness and umbilical artery S/D between the two groups in the second and third trimester(P>0.05);After labor, fetal head circumference increased and umbilical artery S/D decreased in fET group compared with fET group [(33.24±1.08)cm vs(32.49±1.87)cm, P<0.01;(2.07±0.32)cm vs(2.21±0.33)cm, P<0.05],there was no significant difference in abdominal circumference and placental thickness(P>0.05).The gestational age of neonates born after FET was smaller [(270.81±10.03)d vs(274.96±7.48)d, P<0.05],neonatal body mass index increased [(25.94±2.23)kg/m~3 vs(24.75±2.13)kg/m~3,P<0.05].There were no significant differences in birth weight, length, placental weight, birth weight/placental weight and sex ratio between the two groups(P>0.05).Conclusions Fetal growth in utero and neonatal growth indicators after FET are generally better than those after fresh embryo transfer.