Risk factors associated with pre-eclampsia in pregnancies conceived by ART
Risk factors associated with pre-eclampsia in pregnancies conceived by ART
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ART 妊娠中与先兆子痫相关的危险因素
DOI：
10.1016/j.rbmo.2019.09.006
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发表时间：
2019-12-01
影响因子：
4
通讯作者：
Ma, Jinlong
中科院分区：
文献类型：
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作者：
Li, Yan;Zhao, Shigang;Ma, Jinlong
研究问题：哪些因素与使用自体卵母细胞体外受精妊娠的先兆子痫发生率增加相关？设计：一项巢式病例对照研究，来自三个多中心随机试验的联合队列，比较新鲜胚胎移植和冷冻胚胎移植，包括首次胚胎移植后实现临床妊娠的妇女。采用多变量logistic回归评估基线特征、卵巢反应参数、受精类型、胚胎移植类型和妊娠囊数对先兆子痫风险的影响。结果：临床妊娠2965例，确诊子痫前期90例。双胎妊娠（优势比[OR] 2.34, 95%可信区间[CI]1.50-3.66）、平均动脉压（OR 1.04, 95% CI 1.01-1.07）、冷冻胚胎移植（OR 2.06, 95% CI 1.27-3.35）、体重指数（BMI） （OR 1.10, 95% CI 1.02-1.18）、人绒毛膜促性腺激素触发当天的孕酮水平（OR 1.53, 95% CI 1.07-2.20）和促性腺激素总剂量（OR 0.999, 95% CI 0.999-1.000, P = 0.037）与先兆子痫的风险相关。当分析仅限于接受冷冻胚胎移植的妇女时，双胎妊娠（OR 2.44, 95% CI 1.43-4.18）、BMI （OR 1.13, 95% CI 1.03-1.23）和促性腺激素总剂量（OR 0.999, 95% CI 0.999-1.000, P = 0.014）仍与先兆子痫的风险相关。移植时的胚胎阶段未包括在最终模型中。结论：冷冻胚胎移植是辅助生殖技术中先兆子痫的独立危险因素。卵巢的高反应也可能增加先兆子痫的风险。移植时的胚胎阶段与先兆子痫的风险无关。
Research question: What are the factors associated with the increased incidence of pre-eclampsia in pregnancies conceived through IVF using autologous oocytes?Design: A nested case-control study from the combined cohort of three multicentre randomized trials comparing fresh to frozen embryo transfer, including women who achieved clinical pregnancy after the first embryo transfer. Multivariable logistic regression was used to assess the effect of baseline characteristics, ovarian response parameters, type of fertilization, type of embryo transfer, and number of gestational sacs on the risk of pre-eclampsia.Results: There were 2965 clinical pregnancies and 90 women were diagnosed with pre-eclampsia. Twin gestations (odds ratio [OR] 2.34, 95% confidence interval [CI]1.50-3.66), mean arterial pressure (OR 1.04, 95% CI 1.01-1.07), frozen embryo transfer (OR 2.06, 95% CI 1.27-3.35), body mass index (BMI) (OR 1.10, 95% CI 1.02-1.18), progesterone level on the day of human chorionic gonadotrophin trigger (OR 1.53, 95% CI 1.07-2.20), and the total dose of gonadotrophin (OR 0.999, 95% CI 0.999-1.000, P = 0.037) were associated with the risk of pre-eclampsia. When the analysis was confined to women who underwent frozen embryo transfer, twin gestations (OR 2.44, 95% CI 1.43-4.18), BMI (OR 1.13, 95% CI 1.03-1.23) and the total dose of gonadotrophin (OR 0.999, 95% CI 0.999-1.000, P = 0.014) were still related to the risk of pre-eclampsia. The embryo stage at transfer was not included in the final models.Conclusions: Frozen embryo transfer was an independent risk factor of pre-eclampsia in assisted reproductive technology. The high ovarian response may also increase the risk of pre-eclampsia. The embryo stage at transfer was not related to the risk of pre-eclampsia.