体外受精/卵胞浆内单精子注射⁃胚胎移植术后单胎妊娠早产的危险因素分析

Analysis of risk factors for preterm delivery in singleton pregnancies after in vitro fertilization/intracytoplasmic sperm injection⁃embryo transfer

目的探究接受体外受精/卵胞浆内单精子注射⁃胚胎移植(in⁃vitro fertilization/intracytoplasmic sperm injection⁃embryo transfer,IVF/ICSI⁃ET)助孕后单胎妊娠早产的独立危险因素。方法采用巢式病例对照研究设计,纳入2014年1月至2022年12月于四川大学华西第二医院行IVF/ICSI⁃ET助孕后单胎妊娠并分娩的患者3079例,收集社会人口学资料、IVF/ICSI⁃ET临床资料和孕期并发症资料,随防至分娩。根据分娩孕周将其分为早产组(240例)和足月产组(2839例),采用单因素分析筛选差异变量,将后者纳入多因素Logistic回归分析筛选早产的独立危险因素。结果女方吸烟史(OR=3.416,95%CI:1.429⁃8.165,P=0.006)、大月份流产史(OR=3.451,95%CI:1.559⁃7.636,P=0.002)、前置胎盘(OR=7.035,95%CI:3.874⁃12.775,P<0.001)、胎盘早剥(OR=3.859,95%CI:1.429⁃10.426,P=0.008)、妊娠期高血压(OR=5.560,95%CI:3.136⁃9.858,P<0.001)及妊娠期肝内胆汁淤积症(OR=2.780,95%CI:1.335⁃5.793,P=0.006)是IVF/ICSI⁃ET助孕后患者发生早产的独立危险因素。结论对于接受IVF/ICSI⁃ET助孕后单胎妊娠的患者,有吸烟史、大月份流产史、合并妊娠期高血压、前置胎盘、胎盘早剥及妊娠期肝内胆汁淤积症者发生早产的风险较高,应予以充分关注。

Objective To investigate the independent risk factors for preterm delivery of singleton pregnancies after in⁃vitro fertilization/intracytoplasmic sperm injection⁃embryo transfer(IVF/ICSI⁃ET).Methods A nested case⁃control study included 3079 pregnant women with singleton live births after IVF/ICSI⁃ET at West China Second Hospital of Sichuan University from January 2014 to December 2022.The sociodemographic information,IVF/ICSI⁃ET⁃related clinical information and pregnancy complications of participants were collected,after follow⁃up,all participants were divided into preterm delivery group(240 cases)and term delivery group(2839 cases)based on the gestational week.Univariate analyses was used to filter for differential variables,and the latter was included in multivariate Logistic regression analyses to filter for independent risk factors for premature birth.Results Female smoking history(OR=3.416,95%CI:1.429⁃8.165,P=0.006),history of late abortion(OR=3.451,95%CI:1.559⁃7.636,P=0.002),placenta previa(OR=7.035,95%CI:3.874⁃12.775,P<0.001),placental abruption(OR=3.859,95%CI:1.429⁃10.426,P=0.008),gestational hypertension(OR=5.560,95%CI:3.136⁃9.858,P<0.001)and intrahepatic cholestasis in pregnancy(OR=2.780,95%CI:1.335⁃5.793,P=0.006)were independent risk factors of preterm delivery for singleton pregnancies after IVF/ICSI⁃ET.Conclusion In patients with pregnancies after IVF/ICSI⁃ET,the risk of preterm delivery is higher in women with a history of smoking,history of late abortion,hypertensive disorders of pregnancy,placenta previa,placental abruption,and intrahepatic cholestasis in pregnancy,these patients should be paid more attention.