Peak serum estradiol level during controlled ovarian hyperstimulation is associated with increased risk of small for gestational age and preeclampsia in singleton pregnancies after in vitro fertilization
Peak serum estradiol level during controlled ovarian hyperstimulation is associated with increased risk of small for gestational age and preeclampsia in singleton pregnancies after in vitro fertilization
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DOI：
10.1016/j.fertnstert.2012.03.028
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发表时间：
2012-06-01
影响因子：
6.7
通讯作者：
Styer, Aaron K.
中科院分区：
文献类型：
--
作者：
Imudia, Anthony N.;Awonuga, Awoniyi O.;Styer, Aaron K.
目的：评估血清E-2峰值水平(EPE2；定义为水平和GT；在控制性超排卵(COH)中注射hCG当天)对小于胎龄儿(SGA)、先兆子痫(Pree)、设计：回顾性队列研究。地点：三级保健学术医学中心。患者(S)：新鲜体外受精后妊娠的单胎活产妊娠。干预组(S)：无。主要结局指标(S)：胎龄性早产率、胎盘早产率及胎盘发育情况。结果(S)：慢性阻塞性肺疾病合并胎盘早产儿的发生率(7例[26.9%]vs.10例[3.8%]；优势比[OR]，95%可信区间[CI]{9.40，3.22-27.46})和发展Pree(5[18.5%]比12[4.5%]；调整后的OR，95%CI{4.79，1.55-14.84})。未发现EPE2与妊娠37周、35周或32周前分娩的可能性有关。受试者操作特征分析显示，EPE2水平预测产科不良结局(SGA+Pree)的敏感性和特异性分别为38.5%和91.7%。以血清E-2峰值3450pg/mL90百分位数为界值，阳性预测值为37%，阴性预测值为92%。结论(S)：COH期间应用hCG当天的EPE2水平(3450pg/mL)与IVF周期单胎妊娠发生Pree和分娩SGA的几率较大。(Fertil Steril(R)2012；97：1374-9。(C)2012年，由美国生殖医学学会主办。)
Objective: To assess the impact of elevated peak serum E-2 levels (EPE2; defined as levels >90th percentile) on the day of hCG administration during controlled ovarian hyperstimulation (COH) for IVF on the likelihood for small for gestational age (SGA), preeclampsia (PreE), and preterm delivery (PTD) in singleton pregnancies.Design: Retrospective cohort study.Setting: Tertiary-care academic medical center.Patient(s): Singleton live-birth pregnancies conceived after fresh IVF-ET.Intervention(s): None.Main Outcome Measure(s): The delivery rate of SGA infants and the development of PreE and PTD in patients with and without EPE2.Result(s): Patients with EPE2 during COH were more likely to deliver SGA infants (7 [26.9%] vs. 10 [3.8%]; odds ratio [OR], 95% confidence interval [CI] {9.40, 3.22-27.46}) and develop PreE (5 [18.5%] vs. 12 [4.5%]; adjusted OR, 95% CI {4.79, 1.55-14.84}). No association was found between EPE2 and the likelihood for delivery before 37 weeks, 35 weeks, or 32 weeks of gestation. Receiver operating characteristic analysis revealed that EPE2 level predicted adverse obstetrical outcome (SGA + PreE) with 38.5% and 91.7% sensitivity and specificity, respectively. Using a serum peak E-2 cutoff value of 3,450 pg/mL (>90th percentile level), the positive predictive value was 37%, while the negative predictive value was 92%.Conclusion(s): EPE2 level (>3,450 pg/mL) on the day of hCG administration during COH is associated with greater odds of developing PreE and delivery of an SGA infant in singleton pregnancies resulting from IVF cycles. (Fertil Steril (R) 2012;97:1374-9. (C) 2012 by American Society for Reproductive Medicine.)