Perinatal outcomes in singletons following in vitro fertilization: A meta-analysis
Perinatal outcomes in singletons following in vitro fertilization: A meta-analysis
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DOI：
10.1097/01.aog.0000114989.84822.51
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发表时间：
2004-03-01
影响因子：
7.2
通讯作者：
Croughan, MS
中科院分区：
文献类型：
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作者：
Jackson, RA;Gibson, KA;Croughan, MS
目的：在校正年龄和产次的研究中，评估体外受精（IVF）后的单胎妊娠是否比自然受孕有更高的围产期死亡率、早产、小于胎龄儿、低出生体重或极低出生体重的风险。数据来源：我们检索了MEDLINE、BIOSIS、在线博士论文、参考书目和会议记录，以查找1978 - 2002年的研究，使用术语"体外受精，"女性不孕症治疗"和"生殖技术"结合"胎儿死亡"、"死亡率"、"胎儿生长受限"、"小于胎龄儿"、"出生体重"、"早产"、"早产"、"婴儿"、"产科"、"围产期"和"新生儿"。"研究选择方法：纳入标准是IVF后单胎妊娠与自然受孕的比较，控制产妇年龄和产次;上述结果的I;以及确定这些结果的风险比或数据。研究选择和数据提取进行了两次重复后删除identifiinginformation.TABULATION，整合，和结果：15项研究，包括12,283 IVF和190万自发受孕的单胎被确定。进行了随机效应荟萃分析。与自然受孕相比，IVF单胎妊娠与所检查的每种围产期结局的显著更高几率相关：围产期死亡率（比值比[OR] 2.2; 95%置信区间[CI] 1.6，3.0），早产（OR 2.0; 95%CI 1.7，2.2）、低出生体重（OR 1.8; 95%CI 1.4，2.2）、极低出生体重（OR 2.7; 95%CI 2.3，3.1）和小于胎龄儿（OR 1.6; 95%CI 1.3，2.0）。仅早产和低出生体重儿存在统计学异质性。敏感性分析显示结果无显著变化。早产儿。分娩，自发性早产，前置胎盘，妊娠期糖尿病，先兆子痫，新生儿重症监护入院也显着更为普遍的IVF group.CONCLUSION：体外受精患者应被告知的风险增加不良围产期结局。产科医生不仅应将这些妊娠作为高危妊娠进行管理，还应避免选择性早产引产或剖宫产造成的医源性伤害。(C)2004年由美国妇产科医师学会。
OBJECTIVE: To estimate whether singleton pregnancies following in vitro fertilization (IVF) are at higher risk of perinatal mortality, preterm delivery, small for gestational age, and low or very low birth weight compared with spontaneous conceptions in studies that adjusted for age and parity.DATA SOURCES: We searched MEDLINE, BIOSIS, Doctoral Dissertations On-Line, bibliographies, and conference proceedings for studies from 1978-2002 using the terms "in vitro fertilization," "female infertility therapy," and "reproductive techniques" combined with "fetal death," "mortality," "fetal growth restriction," "small for gestational age," "birth weight," "premature labor," "pre-term delivery," "infant," "obstetric," "perinatal," and "neonatal."METHODS OF STUDY SELECTION: Inclusion criteria were singleton pregnancies following IVF compared with spontaneous conceptions, control for maternal age and parity; I of the above outcomes; and risk ratios or data to determine them. Study selection and data abstraction were performed in duplicate after removing identifying information.TABULATION, INTEGRATION, AND RESULTS: Fifteen studies comprising 12,283 IVF and 1.9 million spontaneously conceived singletons were identified. Random-effects meta-analysis was performed. Compared with spontaneous conceptions, IVF singleton pregnancies were associated with significantly higher odds of each of the perinatal outcomes examined: perinatal mortality (odds ratio [OR] 2.2; 95% confidence interval [CI] 1.6, 3.0), preterm delivery (OR 2.0; 95% CI 1.7,2.2), low birth weight (OR 1.8; 95% CI 1.4, 2.2), very low birth weight (OR 2.7; 95% CI 2.3, 3.1), and small for gestational age (OR 1.6; 95% CI 1.3, 2.0). Statistical heterogeneity was noted only for preterm delivery and low birth weight. Sensitivity analyses revealed no significant changes in results. Early preterm. delivery, spontaneous preterm delivery, placenta previa, gestational diabetes, preeclampsia, and neonatal intensive care admission were also significantly more prevalent in the IVF group.CONCLUSION: In vitro fertilization patients should be advised of the increased risk for adverse perinatal outcomes. Obstetricians should not only manage these pregnancies as high risk but also avoid iatrogenic harm caused by elective preterm labor induction or cesarean. (C) 2004 by The American College of Obstetricians and Gynecologists.