Assessing the risk of preterm birth for newborns with congenital heart defects conceived following infertility treatments: a population-based study.
Assessing the risk of preterm birth for newborns with congenital heart defects conceived following infertility treatments: a population-based study.
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DOI：
10.1136/openhrt-2018-000836
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发表时间：
2018
期刊：
影响因子：
2.7
通讯作者：
EPICARD Study Group
中科院分区：
文献类型：
--
作者：
Tararbit K;Lelong N;Goffinet F;Khoshnood B;EPICARD Study Group
量化不孕不育治疗后先天性心脏缺陷（CHDs）新生儿早产（PTB）的风险，并探讨多胎妊娠在不孕不育治疗与CHD新生儿PTB之间的关系。我们使用的数据来自一项基于人群的前瞻性队列研究（EPICARD epidsammiologie des CARDiopathies congacimnitales），包括2190名患有冠心病的新生儿，并排除2005年5月至2008年4月期间居住在大巴黎地区的妇女所生的房间隔缺陷病例。统计分析包括考虑潜在混杂因素（产妇特征、侵入性产前检查、冠心病产前诊断、药物引产/分娩前剖腹产、出生年份）的逻辑回归。多胎妊娠的作用采用路径分析方法进行评估，允许将不孕症治疗对肺结核风险的总影响分解为间接（由不孕症治疗和多胎妊娠之间的关联介导）和直接（由多胎妊娠以外的机制介导）影响。不孕症治疗后妊娠的CHD新生儿发生PTB的比例为40.6% (95% CI 28.7 ~ 52.5)，而自然妊娠的新生儿发生PTB的比例为12.7% (95% CI 11.3 ~ 14.2) （p<0.001）。在考虑了潜在的混杂因素后，不孕症治疗与PTB的几率增加5.0倍相关（校正OR=5.0, 95% CI 2.9至8.6）。与不孕症治疗相关的PTB高风险中约有三分之二是间接影响（即由于多胎妊娠），三分之一是直接影响（即不是由多胎妊娠介导）。不孕症治疗后出生的冠心病新生儿患PTB的风险特别高，其中40%以上的人面临冠心病和PTB的“双重危险”。
To quantify the risk of preterm birth (PTB) for newborns with congenital heart defects (CHDs) conceived following infertility treatments, and to examine the role of multiple pregnancies in the association between infertility treatments and PTB for newborns with CHD. We used data from a population-based, prospective cohort study (EPICARD EPIdémiologie des CARDiopathies congénitales) including 2190 newborns with CHD and excluding cases with atrial septal defects born to women living in the Greater Paris area between May 2005 and April 2008. Statistical analysis included logistic regression to take into account potential confounders (maternal characteristics, invasive prenatal testing, CHD prenatal diagnosis, medically induced labour/caesarean section before labour, birth year). The role of multiple pregnancies was assessed using a path-analysis approach, allowing decomposition of the total effect of infertility treatments on the risk of PTB into its indirect (mediated by the association between infertility treatments and multiple pregnancies) and direct (mediated by mechanisms other than multiple pregnancies) effects. PTB occurred for 40.6% (95% CI 28.7 to 52.5) of newborns with CHD conceived following infertility treatments vs 12.7% (95% CI 11.3 to 14.2) for spontaneously conceived newborns (p<0.001). After taking into account potentially confounding factors, infertility treatments were associated with a 5.0-fold higher odds of PTB (adjusted OR=5.0, 95% CI 2.9 to 8.6). Approximately two-thirds of this higher risk of PTB associated with infertility treatments was an indirect effect (ie, due to multiple pregnancies) and one-third was a direct effect (ie, not mediated by multiple pregnancies). Newborns with CHD conceived following infertility treatments are at a particularly high risk of PTB, exposing over 40% of them to the ‘double jeopardy’ of CHD and PTB.