辅助生殖技术助孕后发生前置胎盘风险的Meta分析

Meta Analysis of the Risk of Placenta Previa After Assisted Reproductive Technology Assisted Pregnancy

目的系统评价辅助生殖技术(assisted reproductive technology,ART)助孕后发生前置胎盘(placenta previa,PP)的风险。方法计算机检索PubMed、Web of Science、中国知网、万方和维普数据库,搜集从建库至2022-05-01日发表的有关ART助孕后发生PP结局的队列研究。由3位研究者独立筛选文献、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,其中发表偏倚采用Begger′s和Eegger′s检验进行评估。采用优势比(odds ratio,OR)及其95%置信区间(confidence interval,CI)来表示ART和PP之间的关系,分析数据并根据随机效应模型报告结果。结果截止2022-05-01日共纳入11篇队列研究,包括ART助孕子代27792例。Meta分析结果显示,ART会显著增加PP发生风险(OR=2.21,95%CI:1.72~2.84,P<0.001),敏感性分析显示结果较稳定。亚组分析的结果显示,不同随访时间、ART类型、纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)评分、样本总量、校正因素数量均会使ART助孕后PP发生风险增加。结论基于观察性研究的优势比报告显示ART是PP发生的一个危险因素。

Objective To systematicly evaluate the risk of placenta previa(PP)after assisted reproductive technology(ART)assisted pregnancy.Methods PubMed,Web of Science,China National Knowledge Infrastructure,Wanfang and VIP databases were searched by computer,cohort studies on PP outcomes after ART published from inception of the database to May 1,2022 were collected.The literatures were screened,the data was extracted and the risk of bias of the included studies was evaluated by 3 researchers independently,Stata 10.1 software was used for meta-analysis,among which the publication bias was evaluated by Begger's and Eegger's tests.The odds ratio(OR)and 95%confidence in-terval(CI)were used to represent the relationship between ART and PP,the data were analyzed and the results were re-ported based on random-effects model.Results A total of 11 cohort studies,including 27792 children born by ART,were included by May 1,2022.Meta-analysis showed that ART could significantly increase the risk of PP[OR=2.21,95%CI:1.72-2.84,P<0.001],and sensitivity analysis showed that the results were stable.The results of subgroup analysis showed that different follow-up time,ART type,Newcastle-Ottawa Scale(NOS)score,total sam-ple size and number of correction factors all increased the risk of PP after ART assisted pregnancy.Conclusion The odds ratio report based on observational study shows that ART is a risk factor for PP.