Impact of single embryo transfer policy on perinatal outcomes in fresh and frozen cycles-analysis of the Japanese Assisted Reproduction Technology registry between 2007 and 2012
Impact of single embryo transfer policy on perinatal outcomes in fresh and frozen cycles-analysis of the Japanese Assisted Reproduction Technology registry between 2007 and 2012
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DOI：
10.1016/j.fertnstert.2015.10.002
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发表时间：
2016-02-01
影响因子：
6.7
通讯作者：
Sakumoto, Tetsuro
中科院分区：
文献类型：
--
作者：
Takeshima, Kazumi;Jwa, Seung Chik;Sakumoto, Tetsuro
目的：研究日本单胚胎移植（SET）政策的引入是否改善了围产期结局。设计：回顾性队列研究。设置：不适用。患者：回顾了2007年至2012年间日本通过辅助生殖技术受孕的140，718例活产和510例死胎（妊娠22周后）。干预：无。主要结局指标：早产（PTB）、低出生体重（LBW）、极低出生体重（VLBW）、小于胎龄儿（SGA）、大于胎龄儿（LGA）、围产儿死亡率和其他妊娠并发症。SET比率从2007年的52.2%大幅上升至2012年的82.6%，而同期多胎妊娠率则由10.7%显著下降至4.1%。PTB、LBW、SGA发生率显著下降，LGA发生率显著上升。围生儿死亡率新鲜周期从0.70%下降到0.40%，而冷冻周期没有变化。与SET相比，ET ≥ 2倍与多胎妊娠、胎盘植入、早产胎膜早破、剖宫产、PTB、LBW、SGA和早期新生儿死亡的风险显著增加相关。与SET政策出台前相比，多胎妊娠、CS、32周前早期PTB、LBW、VLBW和SGA的风险在SET政策出台后显著降低，新鲜/冷冻状态具有显著的交互作用。SET政策的影响是不同的新鲜和冷冻周期的几个围产期的结果。(C)2016年美国生殖医学会（American Society for Reproductive Medicine）
Objective: To investigate whether the introduction of single embryo transfer (SET) policy in Japan has improved perinatal outcomes.Design: A retrospective cohort study.Setting: Not applicable.Patient(s): A total of 140,718 live births and 510 stillbirths (after 22 weeks of gestation) conceived by assisted reproductive technology in Japan between 2007 and 2012 were reviewed.Intervention(s): None. Main Outcome Measure(s): Preterm birth (PTB), low birth weight (LBW), very low birth weight (VLBW), small for gestational age (SGA), large for gestational age (LGA), perinatal mortality, and other pregnancy complications.Result(s): The rate of SET increased significantly from 52.2% in 2007 to 82.6% in 2012, while the rate of multiple pregnancy decreased significantly from 10.7% to 4.1% over the same period. The rates of PTB, LBW, and SGA decreased significantly, while that of LGA increased. Perinatal mortality decreased from 0.70% to 0.40% in fresh cycles, while that of frozen cycles did not change. Double ET or more was associated with a significantly increased risk for multiple pregnancy, placenta accreta, preterm premature rupture of membrane, cesarean section (CS), PTB, LBW, SGA, and early neonatal death compared with SET. Compared with before the SET policy was launched, the risks of multiple pregnancy, CS, early PTB before 32 weeks, LBW, VLBW, and SGA were significantly decreased after the policy was launched, with significant interactions of fresh/frozen status.Conclusion(s): The results suggest that the SET policy improved perinatal outcomes in Japan. The impact of SET policy was different in fresh and frozen cycles for several perinatal outcomes. (C) 2016 by American Society for Reproductive Medicine.)