辅助生殖技术对子代脑瘫影响的Meta分析

Meta analysis of the effects of assisted reproductive technology on the cerebral palsy of offspring

目的系统评价辅助生殖技术(assisted reproductive technology,ART)助孕对子代脑瘫发生的影响。方法计算机检索Pubmed、Web of Science、万方、维普、中国知网数据库自建库至2022年3月发表的关于评价或探讨ART子代脑瘫发生风险的队列研究,对纳入的研究进行筛选、资料提取及Newcastle-Ottawa Scale(NOS)量表文献质量评价,应用Stata 15.0软件行Meta分析。结果最终纳入10篇文献,ART子代共213732例,自然妊娠子代9022009例。Meta分析结果显示,ART子代和IVF子代脑瘫发生风险增加(ART,RR=1.88,95%CI:1.41-2.49,P<0.001;IVF:RR=2.09,95%CI:1.69-2.58,P<0.001)。Meta回归分析结果显示:数据来源与随访时间为潜在的异质性因素(P<0.1)。亚组分析结果显示:数据来源于注册的ART子代脑瘫发生风险增加(RR=1.62,95%CI:1.20-2.18);NOS评分≥7分的亚组,其ART子代脑瘫发生风险RR值为1.85(95%CI:1.35-2.54)。但漏斗图和Egger’s检验提示纳入文献存在发表偏倚(P<0.05),剪补法显示结果未受发表偏倚影响。结论ART子代脑瘫发生高于自然妊娠子代,但该结论尚需更多高质量、多中心、前瞻性研究进一步验证。

Objective Systematic review of the impact of assisted reproductive technology(ART)on cerebral palsy in their offspring.Methods The cohort studies were retrieved that meet the pre-inclusion criteria in the PubMed,Web of Science,Wanfang,VIP and CNKI databases from the establishment of the database to March 2022.These cohort studies about the correlation between ART and cerebral palsy incidence were collected,screened,extracted data and evaluated qualities with Newcastle-Ottawa Scale(NOS).Meta-analysis was then performed by using Stata 15.0 software.Results 10 studies were finally included to assess the risk of cerebral palsy in 213732 offspring after ART and 9022009 offspring of natural conception(NC).Meta-analysis demonstrated that compared with NC offspring,risk of cerebral palsy of ART and in vitro fertilization(IVF)were both increased(ART,RR=1.88,95%CI:1.41-2.49,P<0.001;IVF:RR=2.09,95%CI:1.69-2.58,P<0.001).Meta regression analysis demonstrated that data sources and follow-up years in these studies were potential heterogeneity factors(P<0.1).Subgroup analysis demonstrated that risk of cerebral palsy from registered source was increased in ART offspring(RR=1.62,95%CI:1.20-2.18).In the subgroup with NOS score≥7,the RR value of the risk of cerebral palsy in ART offspring was 1.85(95%CI:1.35-2.54).However,funnel diagram and Egger’s text were showed that there was population bias in the total effective(P<0.05).The result of Trim and fill method with fixed model showed that the results were not affected by population bias.Conclusion The risk of cerebral palsy of ART offspring is higher than that of NC group.However,more multicenter,higher quality,and prospective studies are needed to further validation.