新的证据表明,体外受精(IVF)与某些胎盘异常或并发症的高风险相关。如胎盘早剥,先兆子痫,和早产。然而,缺乏针对IVF治疗后胎盘异常或并发症的大量基于人群的分析.这项研究旨在评估IVF怀孕期间胎盘异常或并发症的绝对风险。
我们基于医院质量监测系统数据库,对2013年至2018年中国16535852例单胎妊娠分娩结局进行了回顾性队列研究。主要结果包括胎盘异常(前置胎盘,胎盘早剥,胎盘植入,和胎盘形态异常)和胎盘相关并发症(妊娠期高血压,先兆子痫,子痫,早产,胎儿窘迫,和胎儿生长受限(FGR))。使用具有精确母亲年龄的有限三次样条的泊松回归模型来估计IVF和非IVF组的绝对风险。
IVF组(n=183059)比非IVF组(n=16352793)更有可能出现前置胎盘(RR:1.87[1.83-1.91]),胎盘早剥(RR:1.16[1.11-1.21]),胎盘植入(RR:2.00[1.96-2.04]),胎盘形态异常(ARR:2.12[2.07至2.16]),妊娠期高血压(ARR:1.55[1.51-1.59]),先兆子痫(ARR:1.54[1.51-1.57]),早产(ARR:1.48[1.46-1.51]),胎儿窘迫(ARR:1.39[1.37-1.42]),和FGR(RR:1.36[1.30-1.42]),但是在子痫中没有发现显着差异(aRR:0.91[0.80-1.04])。在IVF和非IVF组中,随着母亲年龄的增加,每种结局的绝对风险呈现两种模式:前置胎盘显示的向上曲线,胎盘植入,胎盘形态异常,和妊娠期高血压;胎盘早剥呈J形曲线,先兆子痫,子痫,早产,胎儿窘迫,FGR。
IVF是胎盘异常和胎盘相关并发症的独立危险因素,风险与产妇年龄有关。需要进一步的研究来评估IVF患者及其后代的长期胎盘相关慢性疾病。
Emerging evidence has shown that in-vitro fertilization (IVF) is associated with higher risks of certain placental abnormalities or complications, such as placental abruption, preeclampsia, and preterm birth. However, there is a lack of large population-based analysis focusing on placental abnormalities or complications following IVF treatment. This study aimed to estimate the absolute risk of placental abnormalities or complications during IVF-conceived pregnancy.
We conducted a retrospective cohort study of 16 535 852 singleton pregnancies with delivery outcomes in China between 2013 and 2018, based on the Hospital Quality Monitoring System databases. Main outcomes included placental abnormalities (placenta previa, placental abruption, placenta accrete, and abnormal morphology of placenta) and placenta-related complications (gestational hypertension, preeclampsia, eclampsia, preterm birth, fetal distress, and fetal growth restriction (FGR)). Poisson regression modeling with restricted cubic splines of exact maternal age was used to estimate the absolute risk in both the IVF and non-IVF groups.
The IVF group (n = 183 059) was more likely than the non-IVF group (n = 16 352 793) to present placenta previa (aRR: 1.87 [1.83-1.91]), placental abruption (aRR: 1.16 [1.11-1.21]), placenta accrete (aRR: 2.00 [1.96-2.04]), abnormal morphology of placenta (aRR: 2.12 [2.07 to 2.16]), gestational hypertension (aRR: 1.55 [1.51-1.59]), preeclampsia (aRR: 1.54 [1.51-1.57]), preterm birth (aRR: 1.48 [1.46-1.51]), fetal distress (aRR: 1.39 [1.37-1.42]), and FGR (aRR: 1.36 [1.30-1.42]), but no significant difference in eclampsia (aRR: 0.91 [0.80-1.04]) was found. The absolute risk of each outcome with increasing maternal age in both the IVF and non-IVF group presented two patterns: an upward curve showing in placenta previa, placenta accreta, abnormal morphology of placenta, and gestational hypertension; and a J-shape curve showing in placental abruption, preeclampsia, eclampsia, preterm birth, fetal distress, and FGR.
IVF is an independent risk factor for placental abnormalities and placental-related complications, and the risk is associated with maternal age. Further research is needed to evaluate the long-term placenta-related chronic diseases of IVF patients and their offspring.