体外受精-胚胎移植合并妊娠期糖尿病单胎孕妇临床结局的比较研究

Comparative study of clinical outcome in singleton pregnant women with gestational diabetes mellitus combined with in vitro fertilisation-embryo transfer

目的 分析体外受精-胚胎移植(IVF-ET)合并妊娠期糖尿病(GDM)单胎孕妇的临床结局,以明确冷冻胚胎移植(FET)技术在GDM人群中是否会增加妊娠期及分娩期不良妊娠结局的发生风险。方法 采用回顾性分析方法,选取2020年11月至2022年5月期间在空军军医大学第二附属医院生殖中心行FET且孕期诊断为GDM的单胎足月活产的孕妇114例作为冷冻胚胎组,行新鲜胚胎移植且孕期诊断为GDM的单胎足月活产的孕妇75例作为新鲜胚胎组,选取同期自然妊娠合并GDM单胎足月活产的孕妇229例作为自然妊娠组。分别比较冷冻胚胎组与自然妊娠组、新鲜胚胎组与自然妊娠组孕妇的一般情况、分娩期并发症,以及新生儿不良结局,并进行统计分析。结果 冷冻胚胎组与自然妊娠组孕妇餐后1h血糖(t=2.817)、餐后2h血糖(Z=3.804)、产前体质量指数(BMI)(Z=2.745)、剖宫产史的比例(χ^(2)=11.642)、初产妇的比例(χ^(2)=20.218)、剖宫产率(χ^(2)=17.863)比较差异均有统计学意义(P<0.05)。冷冻胚胎组羊水过多的发生率是自然妊娠组的2.507倍(P=0.017),多因素Logistic回归分析显示:冷冻胚胎组发生产后出血是自然妊娠组的0.215倍(P=0.015,调整后OR=0.215),冷冻胚胎组发生羊水过多是自然妊娠组的4.098倍(P=0.019,调整后OR=4.098)。冷冻胚胎组与自然妊娠组的胎儿腹围及新生儿出生身长、出生体重比较差异均有统计学意义(Z值分别为2.285、3.736、4.935,P<0.05)。冷冻胚胎组巨大儿的发生率是自然妊娠组的2.496倍(P=0.007),多因素Logistic回归分析显示:冷冻胚胎组发生巨大儿是自然妊娠组的4.106倍(P=0.010,调整后OR=4.106)。新鲜胚胎组与自然妊娠组孕妇空腹血糖(FPG)(Z=2.299)、餐后1h血糖(t=2.605)、餐后2h血糖(Z=2.491)、产前BMI(Z=4.683)、活产数≥1的比例(χ^(2)=7.390)、初产妇的比例(χ^(2)=19.534)比较差异均有统计学意义(P<0.05)。新鲜胚胎组产后出血的发生率是自然妊娠组的3.761倍(P=0.006),新鲜胚胎组胎膜早破的发生率是自然妊娠组的0.303倍(P=0.009),多因素Logistic回归分析显示:新鲜胚胎组发生产后出血是自然妊娠组的3.756倍(P=0.029,调整后OR=3.756)。新鲜胚胎组低出生体重儿(LBW)的发生率是自然妊娠组的11.794倍(P<0.001),多因素Logistic回归分析显示:新鲜胚胎组与自然妊娠组巨大儿、LBW、新生儿窒息的发生率比较差异均无统计学意义(P>0.05)。结论 与自然妊娠合并GDM相比,FET增加了羊水过多及巨大儿的发生率,降低了产后出血的发生率;新鲜胚胎移植增加了产后出血的发生率。

Objective To analyse the clinical outcomes of singleton pregnant women with gestational diabetes mellitus(GDM)combined with in vitro fertilization-embryo transfer(IVF-ET),in order to clarify whether the frozen embryo transfer(FET)technique increases the risk of adverse pregnancy outcomes during gestation and delivery in the GDM population.Methods With retrospective analysis,114 pregnant women who underwent FET and had a single full-term live birth with GDM diagnosed during pregnancy at the Reproductive Centre of the Second Affiliated Hospital of Air Force Medical University between November 2020 and May 2022 were selected as the frozen embryo group,75 pregnant women who underwent fresh embryo transfer and had a single full-term live birth with GDM diagnosed during pregnancy as the fresh embryo group,and 229 pregnant women who underwent natural pregnancy combined with GDM as the natural pregnancy group during the same period were selected.Maternal general conditions,complications during labour,and adverse neonatal outcomes were compared between the frozen embryo group and the natural pregnancy group,and between the fresh embryo group and the natural pregnancy group,respectively.Statistical analysis was conducted.Results The differences between the frozen embryo group and the natural pregnancy group were statistically significant when comparing pregnant women's postprandial blood glucose at 1 hour(t=2.817),postprandial blood glucose at 2 hours(Z=3.804),pre-pregnancy body mass index(BMI)(Z=2.745),the proportion of cesarean section history(χ^(2)=11.642),the proportion of primiparous women(χ^(2)=20.218),and the cesarean section rate(χ^(2)=17.863)(all P<0.05).The occurrence of abnormal amniotic fluid in the frozen embryo group was 2.507 times higher than that in the natural pregnancy group(P=0.017).Multivariate logistic regression analysis showed that the frozen embryo group had a 0.215 times lower risk of postpartum hemorrhage compared to the natural pregnancy group(P=0.015,adjusted OR=0.215),and a 4.098 times higher risk of abnormal amniotic fluid(P=0.019,adjusted OR=4.098).There were statistically significant differences in fetal abdominal circumference,neonatal birth weight,and birth length between the frozen embryo group and natural pregnancy group(Z=2.285,3.736,4.935,respectively,P<0.05).The occurrence of macrosomia in the frozen embryo group was 2.496 times higher than that in the natural pregnancy group(P=0.007).The frozen embryo group had a 4.106 times higher risk of macrosomia compared to the natural pregnancy group(P=0.010,adjusted OR=4.106).For the fresh embryo group compared to the natural pregnancy group,there were statistically significant differences in fasting blood glucose(FPG)(Z=2.299),postprandial blood glucose at 1 hour(t=2.605),postprandial blood glucose at 2 hours(Z=2.491),pre-pregnancy BMI(Z=4.683),the proportion of live births≥1(χ^(2)=7.390),and the proportion of primiparous women(χ^(2)=19.534)(all P<0.05).The incidence of postpartum hemorrhage in the fresh embryo group was 3.761 times higher than that in the natural pregnancy group(P=0.006),and the incidence of premature rupture of membranes in the fresh embryo group was 0.303 times lower than that in the natural pregnancy group(P=0.009).The fresh embryo group had a 3.756 times higher risk of postpartum hemorrhage compared to the natural pregnancy group(P=0.029,adjusted OR=3.756).The incidence of low birth weight(LBW)in the fresh embryo group was 11.794 times higher than that in the natural pregnancy group(P<0.001).There was no statistically significant difference in the incidence of macrosomia,LBW,and neonatal asphyxia between the fresh embryo group and natural pregnancy group(all P>0.05).Conclusion Compared with natural pregnancy with GDM,FET increases the incidence of abnormal amniotic fluid and macrosomia and decreases the incidence of postpartum hemorrhage.Fresh embryo transfer increases the incidence of postpartum hemorrhage.