Birthweight of singletons born after cleavage-stage or blastocyst transfer in fresh and warming cycles
Birthweight of singletons born after cleavage-stage or blastocyst transfer in fresh and warming cycles
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DOI：
10.1093/humrep/dex361
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发表时间：
2018-02-01
影响因子：
6.1
通讯作者：
Verheyen, Greta
中科院分区：
文献类型：
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作者：
De Vos, Anick;Santos-Ribeiro, Samuel;Verheyen, Greta
研究问题：在新鲜或玻璃化-加温胚胎移植后，延长培养至囊胚期是否影响单胎出生体重？总结回答：单胎出生体重z评分在新鲜囊胚移植后没有显著变化，而玻璃化冷冻的额外影响仍然不确定。已知情况：观察性研究表明，长期培养与早产和低出生体重的风险增加有关。相反，在出生体重和胎龄方面，玻璃化冷冻后出生的单胎与新鲜移植后出生的单胎相比，围产期结局更好。研究设计，规模，持续时间：我们对新生儿结局的事后队列分析包括447例活产单胎，来自于最近对卵裂期和囊胚移植后累积活产率的回顾性分析。这些婴儿是在新鲜单卵裂期移植（FCT第3天，n = 113）、新鲜单囊胚移植（FBT第5天，n = 218）、玻璃化温热卵裂期移植（VCT第3天，n = 58）或玻璃化温热囊胚移植（VBT第5天，n = 58）后出生的。参与者/材料，设置，方法：单胎出生体重是主要的结局指标。在多变量线性回归分析中，通过使用出生体重z评分来解释新生儿的出生年龄和性别，并调整其他混杂因素（母亲年龄、BMI、产次和吸烟行为）。消失的双胞胎被排除在分析之外。主要结果和机会的作用：与卵裂期移植相比，玻璃化温热第5天组中囊胚移植后观察到显著较低的z评分（P = 0.013），新鲜移植组中未观察到差异（P = 0.32）。多变量回归分析后[调整回归系数（95%置信区间）]，FCT和FBT组对新生儿体重z评分无显著影响[-0.19（-0.44; 0.05）]，但玻璃化囊胚（VBT）移植与低出生体重相关[-0.52（-0.90; -0.15）]与玻璃化冷冻卵裂期胚胎（VCT）移植相比。局限性，预防原因：本队列相对较小，尤其是玻璃化-加温亚组。可能影响出生体重的妊娠相关因素（如糖尿病、高血压、先兆子痫）也未纳入分析。研究结果的更广泛意义：不同的ART程序，包括扩展培养和玻璃化冷冻，可能存在潜在的安全问题。这些结果需要在未来更大规模的研究中进一步证实。
STUDY QUESTION: Does extended culture to the blastocyst stage affect singleton birthweight after either fresh or vitrified-warmed embryo transfer? SUMMARY ANSWER: Singleton birthweight z-scores did not vary significantly after a fresh blastocyst transfer, whereas the additional effect of vitrification remains inconclusive. WHAT IS KNOWN ALREADY: Observational studies have associated extended culture with an increased risk of preterm birth and low birthweight. On the contrary, in terms of birthweight and gestational age, singletons born after vitrification have been associated with a better perinatal outcome when compared to those born following a fresh transfer. STUDY DESIGN, SIZE, DURATION: Our post-hoc cohort analysis on neonatal outcomes included 447 liveborn singletons was derived from a recent retrospective analysis on cumulative live birth rates after cleavage-stage and blastocyst transfers. These babies were born following a fresh single cleavage-stage transfer (FCT Day 3, n = 113), fresh single blastocyst transfer (FBT Day 5, n = 218), vitrified-warmed cleavage-stage transfer (VCT Day 3, n = 58) or vitrified-warmed blastocyst transfer (VBT Day 5, n = 58). PARTICIPANTS/MATERIALS, SETTING, METHODS: Singleton birthweight was the primary outcome measure. Gestational age and gender of the newborn were accounted for by using birthweight z-scores in a multivariable linear regression analysis, adjusting for other confounders (maternal age, BMI, parity and smoking behaviour). Vanishing twins were excluded from the analysis. MAIN RESULTS AND THE ROLE OF CHANCE: A significantly lower z-score was observed after blastocyst transfer compared to cleavage-stage transfer in the vitrified-warmed Day 5 group (P = 0.013), a difference not observed in the fresh transfer groups (P = 0.32). Following multivariable regression analysis [adjusted regression coefficient (95% confidence interval)], the FCT and FBT groups showed no significant influence on the birthweight z-scores after fresh transfer [-0.19 (-0.44; 0.05)], but the transfer of vitrified blastocysts (VBT) was associated with a lower birthweight [-0.52 (-0.90; -0.15)] compared with the transfer of vitrified cleavage-stage embryos (VCT). LIMITATIONS, REASONS FOR CAUTION: The present cohort was relatively small, especially in the vitrified-warmed subgroups. Pregnancy-associated factors possibly influencing birthweight (such as diabetes, hypertension, pre-eclampsia) were also not accounted for in the analysis. WIDER IMPLICATIONS OF THE FINDINGS: Different ART procedures, including extended culture and vitrification, may hold potential safety issues. These results require further confirmation in future larger studies.