江西省辅助生殖技术出生缺陷流行现状及相关因素分析  

Monitoring of birth defects and analysis of correlation factors in assisted reproductive technology in Jiangxi Province

作　　者：夏雷震 赵琰[1] 伍琼芳[1] 吴兴武[1] 黄嘉膂 黄志辉[1] 许定飞[1] 田莉峰[1] Xia Leizhen;Zhao Yan;Wu Qiongfang;Wu Xingwu;Huang Jialyu;Huang Zhihui;Xu Dingfei;Tian Lifeng(Assisted Reproductive Center of Jiangxi Maternal and Child Health Hospital,Jiangxi Assisted Reproductive Technology Quality Control Center,Jiangxi Key Laboratory of Reproductive Health,Nanchang 330006,China)

机构地区：[1]江西省妇幼保健院生殖医学中心、江西省辅助生殖技术质量控制中心、江西省生殖健康与优生优育重点实验室,南昌330006

出　　处：《中华生殖与避孕杂志》2025年第3期267-276,共10页Chinese Journal of Reproduction and Contraception

摘　　要：目的调研2014—2023年江西省辅助生殖技术(assisted reproductive technology,ART)出生缺陷流行病学特征及发展趋势,探讨出生缺陷发生的相关因素。方法回顾性收集2014年1月至2023年12月期间江西省18家生殖中心的ART分娩周期治疗数据及随访结果。分析出生缺陷的流行趋势与疾病类型顺位关系,采用精确概率法估计出生缺陷发生率的95%置信区间(confidence interval,CI),通过Poisson回归分析独立相关因素。结果本研究共纳入65003例ART子代,包括2025例宫腔内人工授精(intrauterine insemination,IUI)子代和62978例体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)子代,总的出生缺陷发生率为13.46‰(95%CI:12.59‰~14.38‰);其中IUI为9.38‰(95%CI:5.66‰~14.61‰),IVF-ET为13.59‰(95%CI:12.70‰~14.53‰)。2014—2023年出生缺陷发生率呈下降趋势(17.11‰至11.47‰,P_(trend)=0.003)。前3位出生缺陷类型分别为循环系统畸形(3.71‰,95%CI:3.25‰~4.21‰)、肌肉骨骼系统畸形(2.37‰,95%CI:2.01‰~2.77‰)和面、耳、眼、颈部畸形(1.23‰,95%CI:0.98‰~1.53‰)。单因素分析显示,ART男婴出生缺陷发生率(14.72‰)高于女婴(12.31‰,P=0.009),此外,出生孕周、出生体质量、胎儿数、不孕原因以及分娩年份与出生缺陷发生率显著相关(P<0.001、P<0.001、P<0.001、P=0.025、P=0.037)。多因素分析结果显示,单胎中,男婴、出生孕周32~36周、出生体质量<1500 g和双方因素不孕是出生缺陷的独立相关因素(OR=1.21,95%CI:1.00~1.47,P=0.046;OR=1.90,95%CI:1.41~2.56,P<0.001;OR=3.37,95%CI:1.33~8.51,P=0.010;OR=1.38,95%CI:1.12~1.69,P=0.003);而多胎中,男婴、出生孕周<32周、出生孕周32~36周、出生体质量<1500 g、出生体质量1500~2499 g、母亲年龄25~29岁以及母亲年龄30~34岁是出生缺陷的独立相关因素(OR=1.25,95%CI:1.03~1.52,P=0.023;OR=2.06,95%CI:1.35~3.15,P=0.001;OR=1.32,95%CI:1.05~1.66,P=0.016;OR=1.98,95%CI:1.19~3.28,P=0.009;OR=2.06,95%CIObjective To investigate the epidemiological characteristics and trends of birth defects related to assisted reproductive technology(ART)in Jiangxi Province from 2014 to 2023,and to explore the correlation factors of birth defect occurrence.Methods A retrospective collection of ART treatment data and follow-up results from January 2014 to December 2023 across 18 reproductive centers in Jiangxi Province was conducted.The trend of birth defects and the rank order of defect types were analyzed.Exact probability methods were used to estimate the 95%confidence intervals(CI)of the incidence rates,and Poisson regression was applied to identify independent correlation factors.Results A total of 65003 ART offspring were included in this study,comprising 2025 offspring from intrauterine insemination(IUI)and 62978 from in vitro fertilization and embryo transfer(IVF-ET).The overall incidence of birth defects was 13.46‰(95%CI:12.59‰-14.38‰),with 9.38‰(95%CI:5.66‰-14.61‰)for IUI and 13.59‰(95%CI:12.70‰-14.53‰)for IVF-ET.The incidence of birth defects showed a decreasing trend from 2014 to 2023(17.11‰to 11.47‰,P_(trend)=0.003).The top three birth defect types were circulatory system defects(3.71‰,95%CI:3.25‰-4.21‰),musculoskeletal system defects(2.37‰,95%CI:2.01‰-2.77‰),and congenital malformations of the face,ears,eyes,and neck(1.23‰,95%CI:0.98‰-1.53‰).Univariate analysis indicated that male offspring from IVF-ET had a higher incidence of birth defects than that in female offspring(14.72‰vs.12.31‰,P=0.009).Additionally,gestational age,birth weight,fetal number,cause of infertility,and year of delivery were significantly associated with birth defect incidence in IVF-ET offspring(P<0.001,P<0.001,P<0.001,P=0.025,P=0.037).Multivariate analysis showed that in singleton pregnancies,male offspring,gestational age 32-36 weeks birth weight<1500 g,and infertility with bilateral factors were independent risk factors for birth defects(OR=1.21,95%CI:1.00-1.47,P=0.046;OR=1.90,95%CI:1.41-2.56,P<0.0

关 键 词：生殖技术 辅助 出生缺陷 发生率 江西省 相关因素 

分 类 号：R714.7[医药卫生—妇产科学]