既往孕产史对首次新鲜周期移植妊娠及围产结局的影响  

Effect of women's reproductive history on live birth rate and perinatal outcome after first IVF-ET

作　　者：张琳琳 黄铄[2] 李蓉[1] Zhang Linlin;Huang Shuo;Li Rong(Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China;Reproductive Medical Center,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院妇产科,北京100191 [2]北京大学第三医院生殖医学中心,北京100191

出　　处：《中华生殖与避孕杂志》2024年第9期906-915,共10页Chinese Journal of Reproduction and Contraception

基　　金：国家杰出青年科学基金(81925013);北京大学第三医院院临床重点项目(BYSYZD2023007)。

摘　　要：目的:探讨既往孕产史是否影响首次体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection and embryo transfer,IVF/ICSI-ET)后的妊娠及围产结局。方法:本研究是一项以2018年1月至2022年12月期间在北京大学第三医院生殖医学中心首次接受IVF/ICSI新鲜周期移植女性为研究对象的回顾性队列研究。根据既往孕产史分为5组:未妊娠组(n=14239)、终止妊娠组(n=4076)、妊娠丢失组(n=1773)、异位妊娠组(n=1169)和活产组(n=857)。通过个案控制匹配女方年龄和移植胚胎数量等关键变量,采用逻辑回归分析校正混杂因素,分析匹配前后既往不同孕产史类型对IVF/ICSI-ET后妊娠与围产结局的影响。结果:最终分析共包括22114例女性。未进行匹配时,以未妊娠组为参照组,校正混杂因素后,有异位妊娠史的患者发生异位妊娠的风险更高(OR=2.134,95%CI:1.262~3.606,P=0.005),本次单胎分娩小于孕龄儿的概率更高(OR=2.005,95%CI:1.248~3.712,P=0.008)。有活产史的患者更易临床妊娠(OR=1.323,95%CI:1.084~1.616,P=0.006)和活产分娩(OR=1.312,95%CI:1.061~1.623,P=0.012),本次双胎分娩的患者更不易发生早产(OR=0.483,95%CI:0.299~0.847,P=0.023)。妊娠丢失组本次单胎分娩小于孕龄儿(OR=2.289,95%CI:1.497~3.491,P=0.002)、双胎分娩早产(OR=1.569,95%CI:1.193~1.916,P=0.006)的风险更高。其他主要妊娠结局和围产结局指标差异均无统计学意义(均P>0.05)。结论:既往孕产史与首次新鲜周期移植的妊娠与围产结局有一定相关性。既往曾异位妊娠的女性再次发生异位妊娠的风险更高,本次单胎分娩的女性分娩小于孕龄儿的风险更高。既往曾活产分娩的女性临床妊娠率及活产率更高,本次双胎分娩的女性更不易早产。既往曾有过妊娠丢失的女性本次单胎妊娠时分娩小于孕龄儿的风险更高,双胎妊娠时早产的风险更高。ObjectiveTo investigate the effect of women's reproductive history on pregnancy and perinatal outcome after first in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET).MethodsThis was a retrospective cohort study of women who had undergone their first IVF/ICSI and fresh cycle embryo transfer between January 2018 and December 2022 at Reproductive Medical Center,Peking University Third Hospital.The women were categorized into five groups based on their reproductive history:no pregnancy group(n=14239),termination of pregnancy group(n=4076),pregnancy loss group(n=1773),ectopic pregnancy group(n=1169),and live birth group(n=857).The women with no previous pregnancy were considered as the reference group.The primary outcome was the live birth rate and secondary endpoints included rates of positive pregnancy test,clinical pregnancy,pregnancy loss and ectopic pregnancy as well as perinatal outcomes such as birth weight and preterm birth.Logistic regression analyses were used to control for a number of potential confounders before and after case control matching for female age and number of embryos transferred.ResultsIn total,22114 women were included in the final analysis.When case control matching was not performed,after correcting for several potential confounders,the risk of ectopic pregnancy(OR=2.134,95%CI:1.262-3.606,P=0.005)and the risk of small-for-gestational age in patients with singleton births(OR=2.005,95%CI:1.248-3.712,P=0.008)after ET was elevated among women with a previous ectopic pregnancy.Previous was more likely to clinical pregnancy(OR=1.323,95%CI:1.084-1.616,P=0.006)and live birth(OR=1.312,95%CI:1.061-1.623,P=0.012),and patients with twin births were less likely to preterm birth(OR=0.483,95%CI:0.299-0.847,P=0.023).The risk of small-for-gestational age after embryo transfer in patients with singleton births(OR=2.289,95%CI:1.497-3.491,P=0.002)and the risk of preterm birth in patients with twins births(OR=1.569,95%CI:1.193-1.916,P=0.006)was elevated among women with a p

关 键 词：受精 体外 胚胎移植 孕产史 活产率 围产结局 

分 类 号：R714.8[医药卫生—妇产科学]