Risk of hypertensive disorders in pregnancies following assisted reproductive technology: a cohort study from the CoNARTaS group
Risk of hypertensive disorders in pregnancies following assisted reproductive technology: a cohort study from the CoNARTaS group
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DOI：
10.1093/humrep/dev090
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发表时间：
2015-07-01
影响因子：
6.1
通讯作者：
Romundstad, L. B.
中科院分区：
文献类型：
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作者：
Opdahl, S.;Henningsen, A. A.;Romundstad, L. B.
研究问题：采用特定辅助生殖技术（ART）妊娠的高血压疾病风险与自然妊娠（SC）妊娠的风险不同吗？结论：ART妊娠有较高的高血压疾病风险，特别是在冷冻保存后，在冷冻解冻周期后的双胎妊娠风险最高。已知情况：ART妊娠发生高血压疾病的风险高于SC妊娠。多胎妊娠和潜在的不孕症可能是增加风险的部分原因，但也不能排除特定的抗逆转录病毒治疗程序的影响。研究设计、规模、持续时间：基于人群的队列研究，包括来自瑞典、丹麦和挪威健康登记的全国数据的同胞设计。参与者/材料、环境、方法：纳入1988 - 2007年间所有登记的ART妊娠和孕龄bb0 = 22周的SC妊娠。ART单胎妊娠（n = 47 088）与SC单胎妊娠（n = 268 599）比较，胎次和出生年份相匹配。ART双胎妊娠（n = 10 918）与SC双胎妊娠（46 674）进行比较。我们使用逻辑回归来估计IVF、ICSI和新鲜或冷冻解冻周期后妊娠高血压疾病的校正优势比和风险差异。我们还使用条件逻辑回归（兄弟姐妹分析）比较了遵循两种程序怀孕的母亲的新鲜和冻融周期。主要结果和偶然性的作用：5.9%的ART单胎妊娠和12.6%的ART双胎妊娠报告了高血压疾病。与单胎妊娠相比，所有ART手术后高血压疾病的风险更高。冻融周期后单胎妊娠风险最高[风险7.0%，风险差1.8%，95%可信区间（CI） 1.2 ~ 2.8]。与双胎妊娠相比，冻融周期后的风险更高（风险19.6%，风险差5.1%,95% CI 3.0-7.1），而新鲜周期后的风险则更高。在同一母亲的兄弟姐妹中，冻融循环后的风险高于新鲜循环（优势比2.63,95% CI 1.73-3.99）。IVF和ICSI的风险没有明显差异。局限性，谨慎的原因：本研究中ART兄弟姐妹的数量有限。残留混杂不能排除。此外，我们没有每位女性史上所有SC妊娠的信息，因此无法比较ART与同一母亲SC妊娠的风险。研究结果的更广泛意义：冻融周期后的妊娠与同一母亲的新鲜周期妊娠相比，高血压疾病的风险更高。冻融循环的安全方面值得进一步关注。研究经费/竞争利益(S)：资金来自欧洲人类生殖和胚胎学会、哥本哈根大学、丹麦科学、技术和创新机构、北欧妇产科学会联合会以及中挪威地区卫生局与挪威科技大学之间的联络委员会。所有作者都没有任何竞争利益需要申报。
STUDY QUESTION: Is the risk of hypertensive disorders in pregnancies conceived following specific assisted reproductive technology (ART) procedures different from the risk in spontaneously conceived (SC) pregnancies?SUMMARY ANSWER: ART pregnancies had a higher risk of hypertensive disorders, in particular following cryopreservation, with the highest risk seen in twin pregnancies following frozen-thawed cycles.WHAT IS KNOWN ALREADY: The risk of hypertensive disorders is higher in ART pregnancies than in SC pregnancies. The increased risk maybe partly explained by multiple pregnancies and underlying infertility, but a contribution from specific ART procedures has not been excluded.STUDY DESIGN, SIZE, DURATION: Population-based cohort study, including sibling design with nationwide data from health registers in Sweden, Denmark and Norway.PARTICIPANTS/MATERIALS, SETTING, METHODS: All registered ART pregnancies and a sample of SC pregnancies with gestational age >= 22 weeks from 1988 to 2007 were included. ART singleton pregnancies (n = 47 088) were compared with SC singleton pregnancies (n = 268 599), matched on parity and birth year. ART twin pregnancies (n = 10 918) were compared with SC twin pregnancies (46 674). We used logistic regression to estimate adjusted odds ratios and risk differences for hypertensive disorders in pregnancies following IVF, ICSI and fresh or frozen-thawed cycles. We also compared freshand frozen-thawed cycles within mothers who had conceived following both procedures using conditional logistic regression (sibling analysis).MAIN RESULTS AND THE ROLE OF CHANCE: Hypertensive disorders were reported in 5.9% of ART singleton and 12.6% of ART twin pregnancies. Comparing singleton pregnancies, the risk of hypertensive disorders was higher after all ART procedures. The highest risk in singleton pregnancies was seen after frozen-thawed cycles [risk 7.0%, risk difference 1.8%, 95% confidence interval (CI) 1.2-2.8]. Comparing twin pregnancies, the risk was higher after frozen-thawed cycles (risk 19.6%, risk difference 5.1%, 95% CI 3.0-7.1), but not after fresh cycles. In siblings, the risk was higher after frozen-thawed cycles compared with fresh cycles within the same mother (odds ratio 2.63, 95% CI 1.73-3.99). There were no clear differences in risk for IVF and ICSI.LIMITATIONS, REASONS FOR CAUTION: The number of ART siblings in the study was limited. Residual confounding cannot be excluded. In addition, we did not have information on all SC pregnancies in each woman's history, and could therefore not compare risk in ART versus SC pregnancies in the same mother.WIDER IMPLICATIONS OF THE FINDINGS: Pregnancies following frozen-thawed cycles have a higher risk of hypertensive disorders, also when compared with fresh cycle pregnancies by the same mother. The safety aspects in frozen-thawed cycles merit further attention.STUDY FUNDING/COMPETING INTEREST(S): Funding was received from the European Society for Human Reproduction and Embryology, the University of Copenhagen, the Danish Agency for Science, Technology and Innovation, the Nordic Federation of Societies of Obstetrics and Gynecology and the Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology. None of the authors has any competing interests to declare.