Reproductive Technologies and the Risk of Birth Defects
Reproductive Technologies and the Risk of Birth Defects
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DOI：
10.1056/nejmoa1008095
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发表时间：
2012-05-10
影响因子：
158.5
通讯作者：
Chan, Annabelle
中科院分区：
文献类型：
--
作者：
Davies, Michael J.;Moore, Vivienne M.;Chan, Annabelle
背景不孕症治疗后的出生缺陷在多大程度上可以由潜在的父母因素解释尚不确定。方法我们将南澳大利亚辅助生殖技术治疗的普查与孕期至少20周或出生体重至少400克的出生和终止登记以及出生缺陷(包括脑瘫和任何妊娠期缺陷终止)联系起来。我们比较了接受辅助生殖技术治疗的妇女怀孕、有过辅助受孕记录但没有接受辅助生殖技术治疗的妇女的自然怀孕(即没有辅助受孕)、有不孕记录但没有接受辅助生殖技术治疗的妇女怀孕以及没有不孕史的妇女怀孕的出生缺陷的风险。与非辅助妊娠相比，涉及辅助受孕的任何出生缺陷(513个缺陷，8.3%)与非辅助受孕(17,546个缺陷，5.8%)的未调整优势比为1.47(95%可信区间，1.33至1.62)；多因素调整后的优势比为1.28(95%可信区间，1.16至1.41)。体外受精(出生缺陷165例，7.2%)与体外受精(95%CI，1.07~1.48)和卵胞浆内单精子注射(ICSI，139例，9.9%)的优势比分别为1.26(95%CI，1.07~1.48)和1.07(95%CI，0.90~1.26)；不孕史，无论有无辅助受孕，也与出生缺陷显著相关。结论在调整父母因素后，与体外受精相关的出生缺陷风险增加不再显著。经多因素调整后，与ICSI相关的出生缺陷风险仍然增加，尽管不能排除残留混杂的可能性。
BackgroundThe extent to which birth defects after infertility treatment may be explained by underlying parental factors is uncertain.MethodsWe linked a census of treatment with assisted reproductive technology in South Australia to a registry of births and terminations with a gestation period of at least 20 weeks or a birth weight of at least 400 g and registries of birth defects (including cerebral palsy and terminations for defects at any gestational period). We compared risks of birth defects (diagnosed before a child's fifth birthday) among pregnancies in women who received treatment with assisted reproductive technology, spontaneous pregnancies (i.e., without assisted conception) in women who had a previous birth with assisted conception, pregnancies in women with a record of infertility but no treatment with assisted reproductive technology, and pregnancies in women with no record of infertility.ResultsOf the 308,974 births, 6163 resulted from assisted conception. The unadjusted odds ratio for any birth defect in pregnancies involving assisted conception (513 defects, 8.3%) as compared with pregnancies not involving assisted conception (17,546 defects, 5.8%) was 1.47 (95% confidence interval [CI], 1.33 to 1.62); the multivariate-adjusted odds ratio was 1.28 (95% CI, 1.16 to 1.41). The corresponding odds ratios with in vitro fertilization (IVF) (165 birth defects, 7.2%) were 1.26 ( 95% CI, 1.07 to 1.48) and 1.07 (95% CI, 0.90 to 1.26), and the odds ratios with intracytoplasmic sperm injection (ICSI) (139 defects, 9.9%) were 1.77 (95% CI, 1.47 to 2.12) and 1.57 (95% CI, 1.30 to 1.90). A history of infertility, either with or without assisted conception, was also significantly associated with birth defects.ConclusionsThe increased risk of birth defects associated with IVF was no longer significant after adjustment for parental factors. The risk of birth defects associated with ICSI remained increased after multivariate adjustment, although the possibility of residual confounding cannot be excluded.