Neonatal outcomes and congenital malformations in children born after dydrogesterone application in progestin-primed ovarian stimulation protocol for IVF: a retrospective cohort study
Neonatal outcomes and congenital malformations in children born after dydrogesterone application in progestin-primed ovarian stimulation protocol for IVF: a retrospective cohort study
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孕激素促卵巢刺激方案 IVF 中应用地屈孕酮后出生儿童的新生儿结局和先天性畸形：一项回顾性队列研究
DOI：
10.2147/dddt.s210228
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发表时间：
2019-01-01
影响因子：
4.8
通讯作者：
Kuang, Yanping
中科院分区：
文献类型：
--
作者：
Huang, Jialyu;Xie, Qin;Kuang, Yanping
目的Dydrogastrin（DYG）是孕激素促排卵（PPOS）方案中的替代药物，具有相似的取卵和妊娠结局。然而，其在新生儿结局和先天性畸形方面的安全性仍不清楚。患者和方法这项回顾性队列研究包括2014年1月至2017年12月使用DYG +人绝经期促性腺激素（hMG）方案（n=1429）或促性腺激素释放激素（GnRH）激动剂短方案（n=2127）体外受精和玻璃化胚胎移植周期后的3556名活产婴儿。新生儿的信息是从标准化的随访问卷和/或出生后7天内的医疗记录中收集的。在调整混杂因素后，通过二元逻辑回归分析卵巢刺激方案和结局指标之间的关系。结果单胎和双胎的分娩方式、新生儿性别、胎龄、出生体重、出生时身长和Z评分在两种方案之间具有可比性。在不良新生儿结局方面，两种方案在调整后的低出生体重、极低出生体重、早产、极早产、小于胎龄儿、大于胎龄儿和早期新生儿死亡率方面差异无统计学意义。此外，DYG + hMG方案中主要先天性畸形的发生率（1.12%）与GnRH激动剂短方案（1.08%）相似，单胎和双胎的校正比值比分别为0.98（95%置信区间[CI]：0.40-2.39）和0.90（95% CI：0.33-2.41）。结论与传统促性腺激素释放激素激动剂短方案相比，在PPOS方案中应用DYG是一种安全的选择，不会影响新生儿结局或增加先天性畸形的风险。
Purpose Dydrogesterone (DYG) has been demonstrated to be an alternative progestin in the progestin-primed ovarian stimulation (PPOS) protocol with comparable oocyte retrieval and pregnancy outcomes. However, its safety regarding neonatal outcomes and congenital malformations is still unclear. Patients and methods This retrospective cohort study included 3556 live-born infants after in vitro fertilization and vitrified embryo transfer cycles using the DYG + human menopausal gonadotropin (hMG) protocol (n=1429) or gonadotropin-releasing hormone (GnRH)-agonist short protocol (n=2127) from January 2014 to December 2017. Newborn information was gathered from standardized follow-up questionnaires and/or access to medical records within 7 days after birth. Associations between ovarian stimulation protocols and outcome measures were analyzed by binary logistic regression after adjusting for confounding factors. Results In both singletons and twins, birth characteristics regarding mode of delivery, newborn gender, gestational age, birthweight, length at birth and Z-scores were comparable between the two protocols. For adverse neonatal outcomes, the two protocols showed no significant differences on the rates of low birthweight, very low birthweight, preterm birth, very preterm birth, small-for-gestational age, large-for-gestational age and early neonatal death after adjustment. Furthermore, the incidence of major congenital malformations in the DYG + hMG protocol (1.12%) was similar to that in the GnRH-agonist short protocol (1.08%), with the adjusted odds ratio of 0.98 (95% confidence interval [CI]: 0.40–2.39) and 0.90 (95% CI: 0.33–2.41) in singletons and twins, respectively. Conclusion Our data suggested that compared with the conventional GnRH-agonist short protocol, application of DYG in the PPOS protocol was a safe option for the newborn population without compromising neonatal outcomes or increasing congenital malformation risks.