Maternal and perinatal outcomes in programmed versus natural vitrified-warmed blastocyst transfer cycles
Maternal and perinatal outcomes in programmed versus natural vitrified-warmed blastocyst transfer cycles
复制标题
DOI：
10.1016/j.rbmo.2020.03.009
复制
发表时间：
2020-08-01
影响因子：
4
通讯作者：
Engmann, Lawrence
中科院分区：
文献类型：
--
作者：
Makhijani, Reeva;Bartels, Chantal;Engmann, Lawrence
研究问题：自然和程序性冷冻胚胎移植（FET）周期之间的孕产妇和围产期结局是否存在差异？设计图：回顾性队列研究在一所大学附属生育中心进行，包括775例患者，他们在2013年至2018年期间接受了程序或自然FET周期，使用玻璃化囊胚进行单胎活产。结果：共分析了384例自然和391例程序FET单胎妊娠。程控FET导致更高的总体母体并发症（32.2% [126/391] vs 18.8% [72/384]; P < 0.01），包括较高的妊娠期高血压疾病（HDP）概率（15.3% [60/391] vs 6.3% [24/384]; P < 0.01），早产胎膜早破（2.6% [10/391]对比0.3% [1/384]; P = 0.02）和剖腹产（53.2% [206/387]对比42.8% [163/381]; P = 0.03）。在控制了潜在的混杂因素后，包括年龄、体重指数、产次、吸烟状况、糖尿病或慢性高血压史、不孕症诊断、移植的胚胎数量和植入前基因检测的使用，与自然FET组相比，HDP的调整优势比为2.39（95% CI 1.37至4.17），总体母体并发症的调整优势比为2.21（95% CI 1.51至3.22）。各组在分析的任何围产期结局（包括出生体重）方面没有显着差异（3357.9 671.6 g vs 3318.4 616.2 g; P = 0.40）或出生缺陷率（1.5% [6/391] vs 2.1% [8/384]; P = 0.57）。玻璃化加温囊胚移植在程序化周期中导致HDP的概率比在自然周期中的移植高两倍。因此，应推荐自然FET周期作为所有接受FET的合格患者的一线治疗，以降低HDP的风险。
Research question: Do maternal and perinatal outcomes differ between natural and programmed frozen embryo transfer (FET) cycles?Design: Retrospective cohort study at a university-affiliated fertility centre including 775 patients who underwent programmed or natural FET cycles resulting in a singleton live birth using blastocysts vitrified between 2013 and 2018.Results: A total of 384 natural and 391 programmed FET singleton pregnancies were analysed. Programmed FET resulted in higher overall maternal complications (32.2% [126/391] versus 18.8% [72/384]; P < 0.01), including higher probability of hypertensive disorders of pregnancy (HDP) (15.3% [60/391] versus 6.3% [24/384]; P < 0.01), preterm premature rupture of membranes (2.6% [10/391] versus 0.3% [1/384]; P = 0.02) and caesarean delivery (53.2% [206/387] versus 42.8% [163/381]; P = 0.03) compared with natural FET. After controlling for potential confounders, including age, body mass index, parity, smoking status, history of diabetes or chronic hypertension, infertility diagnosis, number of embryos transferred and use of preimplantation genetic testing, the adjusted odds ratio for HDP was 2.39 (95% CI 1.37 to 4.17) and for overall maternal complications was 2.21 (95% CI 1.51 to 3.22) comparing programmed with natural FET groups. The groups did not significantly differ for any perinatal outcomes analysed, including birth weight (3357.9 671.6 g versus 3318.4 616.2 g; P = 0.40) or rate of birth defects (1.5% [6/391] versus 2.1% [8/384]; P = 0.57), respectively.Conclusion: Vitrified-warmed blastocyst transfer in a programmed cycle resulted in a twofold higher probability of HDP compared with transfer in a natural cycle. Natural FET cycle should, therefore, be recommended as first line for all eligible patients undergoing FET to reduce the risk of HDP.