背景:滋养外胚层活检已成为植入前遗传检测的主要辅助生殖技术,仅在2019年,就占美国胚胎移植周期的43.8%。尽管流行,滋养外胚层活检后产科和围产期结局的数据仍然稀疏且混合.
目的:本研究旨在检测植入前遗传学检测玻璃化解冻胚泡移植后出生体重和早产不良围产期结局的风险。
方法:这是一项回顾性观察性队列研究,对45,712例单胎活产进行了自体玻璃化解冻的囊胚移植周期,有或没有滋养外胚层活检进行植入前遗传学检测,2014年至2017年期间,参与会员诊所向辅助生殖技术协会国家注册中心报告。分析早产和低出生体重的不良围产期结局。进行多变量回归分析以控制协变量。比较滋养外胚层活检组(n=21,584)和无滋养外胚层活检组(n=24,128),为小于胎龄的结果计算调整后的比值比,大的胎龄,低出生体重<2500克,极低出生体重<1,500克,极低出生体重<1000克,晚期早产<37周,中度早产<34周,早产<28周。
结果:滋养外胚层活检组的女性年龄较大,更有可能怀孕。交货,自然流产史.烟草使用,卵巢储备减少,并且复发性妊娠丢失在滋养外胚层活检组中也更为普遍。外胚层活检与胎龄小(aOR0.97,95%CI0.85-1.12,p值0.72)或胎龄大的新生儿(aOR1.10,95%CI0.99-1.22,p值0.09)无关。活检组和非活检组之间妊娠<37周的早产风险相似(aOR0.93,95%CI0.85-1.02,p值0.11)。滋养外胚层活检与低出生体重<2,500g的风险显着降低相关(aOR0.80,95%CI0.70-0.92,p值<0.001),极低出生体重<1,500g(aOR0.62,95%CI0.46-0.83,p值<0.001),极低出生体重<1,000g(aOR0.48,95%CI0.31-0.74,p值<0.001),中度早产<34周(aOR0.76,95%CI0.64-0.91,p值0.003),和极端早产<28周(aOR0.63,95%CI0.43-0.92,p值0.017)。
结论:滋养外胚层活检与小于胎龄的风险增加无关。大的胎龄,或晚期早产。低出生体重的风险,出生体重很低,在滋养外胚层活检后,中度和极端早产的极低出生体重较低,可能通过选择反对局限性胎盘镶嵌或诱导胎盘表观遗传变化,其机制值得进一步调查。
BACKGROUND: Trophectoderm biopsy has become the mainstay assisted reproductive technique performed for preimplantation genetic testing, accounting for 43.8% of embryo transfer cycles in the United States in 2019 alone. Despite its prevalence, data on the obstetric and perinatal outcomes post-trophectoderm biopsy remains sparse and mixed.
OBJECTIVE: This study aimed to examine the risks of adverse perinatal outcomes in birthweights and prematurity after transfers of the vitrified-thawed blastocyst with trophectoderm biopsy for preimplantation genetic testing.
METHODS: This was a retrospective observational cohort study of 45,712 singleton livebirths resulting from autologous vitrified-thawed blastocyst transfer cycles with or without trophectoderm biopsy for preimplantation genetic testing, reported by participating member clinics to the Society for Assisted Reproductive Technology national registry between 2014 and 2017. Adverse perinatal outcomes of preterm births and low birthweights were analyzed. Multivariable regression analyses were performed to control for covariates. Comparing the trophectoderm biopsy (n=21,584) and no trophectoderm biopsy (n=24,128) groups, adjusted odds ratios were calculated for the outcomes of small-for-gestational-age, large-for-gestational-age, low birthweight <2500 g, very low birthweight <1500 g, extremely low birthweight <1000 g, late preterm births <37 weeks, moderate preterm births <34 weeks, and extremely preterm births <28 weeks.
RESULTS: Women in the trophectoderm biopsy group were older and more likely to have prior pregnancies, deliveries, and a history of spontaneous abortions. Tobacco use, diminished ovarian reserve, and recurrent pregnancy loss were also more prevalent in the trophectoderm biopsy group. Trophectoderm biopsy was not associated with small-for-gestational-age (adjusted odds ratio, 0.97; 95% confidence interval, 0.85-1.12; P=.72) or large-for-gestational-age newborns (adjusted odds ratio, 1.10; 95% confidence interval, 0.99-1.22; P=.09). Risks of preterm births <37 weeks gestation were similar between the biopsy and nonbiopsy groups (adjusted odds ratio, 0.93; 95% confidence interval, 0.85-1.02; P=.11). Trophectoderm biopsy was associated with a significantly lower risk of low birthweight <2500 g (adjusted odds ratio, 0.80; 95% confidence interval, 0.70-0.92; P<.001), very low birthweight <1500 g (adjusted odds ratio, 0.62; 95% confidence interval, 0.46-0.83; P<.001), extremely low birthweight <1000 g (adjusted odds ratio, 0.48; 95% confidence interval, 0.31-0.74; P<.001), moderate preterm birth <34 weeks (adjusted odds ratio, 0.76; 95% confidence interval, 0.64-0.91; P=.003), and extreme preterm birth <28 weeks (adjusted odds ratio, 0.63; 95% confidence interval, 0.43-0.92; P=.02).
CONCLUSIONS: Trophectoderm biopsy is not associated with increased risks of small-for-gestational-age, large-for-gestational-age, or late preterm birth. Risks of low birthweight, very low birthweight, and extremely low birthweight from moderate and extreme preterm births are lower after trophectoderm biopsy, possibly by selecting against confined placental mosaicism or inducing placental epigenetic changes, the mechanisms of which warrant further investigation.