辅助生殖技术与子代先天性心脏病相关性队列研究的Meta分析

Cohort study on correlation between assisted reproductive technology and congenital heart disease in offspring:a meta-analysis

目的系统评价辅助生殖技术(ART)助孕与子代先天性心脏病(CHD)发生的相关性。方法计算机检索中国知网、万方数据库、维普中文数据库、中国生物医学文献数据库等国内数据库以及PubMed、Web of Science、Embase、Scopus等外文数据库,检索有关ART和子代CHD发生相关性的队列研究,检索时限均从建库至2022年3月,并通过人工阅读检索参考文献以避免文献漏检。2名研究者严格按照纳入、排除标准独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 10.1软件进行Meta分析。结果共纳入8篇高质量队列研究,包括ART助孕子代82214例。Meta分析结果显示,ART助孕子代CHD发生风险显著高于自然受孕子代[OR=1.21,95%CI(1.10,1.34),P<0.001]。亚组分析结果显示,不同数据来源、ART类型、ART样本量和未调整母亲糖尿病病史等是ART助孕子代CHD发生风险的显著影响因素(P<0.05)。结论当前证据表明,与自然受孕子代相比,ART助孕子代CHD发生风险可能会增加;母亲有糖尿病病史可能是子代CHD发生风险增加的危险因素。

Objective:To systematically review the correlation between assisted reproductive technology(ART)and the incidence of congenital heart disease(CHD)in offspring.Methods:Domestic databases such as CNKI,Wanfang database,VIP Chinese database,Chinese biomedical literature database,and foreign databases such as PubMed,Web of Science,Embase and Scopus were retrieved by computer to collect the cohort studies on association between ART and congenital heart disease in offspring.The retrieval time was from the establishment of the database to March 2022,and the references were retrieved by manual reading to avoid missing documents.Two reviewers independently screened literature,extracted data and assessed the risk of bias of the included studies in strict accordance with the exclusion criteria for inclusion.Meta-analysis was then performed by using Stata 10.1 software.Results:Eight high-quality cohort studies involving 82214 offspring after ART were included.The results of meta-analysis showed that offspring after ART had a higher CHD risk than controls[OR=1.21,95%CI(1.10,1.34),P<0.001].Subgroup analysis showed that different data sources,ART types,ART sample size,and unadjusted history of maternal diabetes were the influencing factor for the risk of CHD in the offspring of ART assisted pregnancy(P<0.05).Conclusions:Current evidence shows that ART is associated with significantly higher risk of offspring CHD compared with those spontaneously conceived.A history of maternal diabetes may be a risk factor for an increased risk of CHD in the offspring.