Assisted Reproductive Technology Surveillance - United States, 2017.
Assisted Reproductive Technology Surveillance - United States, 2017.
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DOI：
10.15585/mmwr.ss6909a1
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发表时间：
2020-12-18
期刊：
影响因子：
--
通讯作者：
Barfield WD
中科院分区：
文献类型：
--
作者：
Sunderam S;Kissin DM;Zhang Y;Jewett A;Boulet SL;Warner L;Kroelinger CD;Barfield WD
自1981年美国第一个通过辅助生殖技术（ART）受孕的婴儿出生以来，ART的使用和提供ART服务的生育诊所数量在美国稳步增加。ART包括在实验室中处理卵子或胚胎的生育治疗（即，体外受精[IVF]和相关程序）。虽然大多数通过ART受孕的婴儿都是单胞胎，但接受ART手术的妇女比自然受孕的妇女更有可能生多胞胎，因为多个胚胎可能会被转移。多胎分娩可能对母亲和婴儿造成重大风险，包括产科并发症、早产（<37周）和低出生体重（<2 500 g）。本报告提供了美国（包括哥伦比亚特区和波多黎各）2017年进行的ART手术的州特定信息，并将2017年发生的出生结果（由2016年和2017年进行的ART手术产生）与2017年在美国出生的所有婴儿的结果进行了比较。2017. 1995年，疾病预防控制中心开始根据1992年《生育诊所成功率和认证法案》（公共法102-493 [1992年10月24日]）的规定收集美国生育诊所进行的ART手术的数据。通过国家抗逆转录病毒治疗监测系统（NASS）收集数据，这是一个由疾病预防控制中心开发的基于网络的数据收集系统。本报告包括来自50个州、哥伦比亚特区和波多黎各的数据。2017年，美国448家生育诊所共进行了196，454例ART手术（范围：阿拉斯加162例，加州24，179例），其中至少有一个胚胎被转移，并向CDC报告。这些程序导致68 908例活产（范围：波多黎各67例至加利福尼亚8 852例）和78 052名婴儿出生（范围：波多黎各85例至加州9 926例）。在全国范围内，每100万育龄妇女（15-44岁）进行的抗逆转录病毒疗法手术数量为3 040例。在14个州（康涅狄格州、特拉华州、哥伦比亚特区、夏威夷、伊利诺伊州、马里兰州、马萨诸塞州、新罕布什尔州、新泽西、纽约、罗得岛、犹他州、佛蒙特州和弗吉尼亚州），抗逆转录病毒疗法的使用率超过了全国使用率。在7个州（康涅狄格州、哥伦比亚特区、伊利诺伊州、马里兰州、马萨诸塞州、新泽西和纽约），抗逆转录病毒疗法的使用率超过全国使用率的1.5倍。在全国范围内，在所有抗逆转录病毒疗法移植程序中，移植胚胎的平均数量随着年龄的增加而略有增加（35岁以下妇女为1.3个，35-37岁妇女为1.4个，37岁以上妇女为1.5个）。今年，所有胚胎移植程序中的单胚胎移植（SET）率，而不是以前报道的选择性单胚胎移植程序。全国SET率为67.3%（范围：南达科他州38.9%至特拉华州90.4%），65.0%（范围：波多黎各23.6%至特拉华州89.4%）和60.0%（范围：波多黎各为28.6%，特拉华州为83.1%）。2017年，ART占美国出生的所有婴儿的1.9%（范围：波多黎各的0.4%到马萨诸塞州的5.0%）。大约73.6%的ART妊娠婴儿是单胎婴儿。总体而言，ART占所有多胞胎的14.7%，包括所有双胞胎婴儿的14.7%和所有三胞胎及以上婴儿的17.3%。ART受孕的双胞胎约占多胎分娩的所有ART受孕婴儿的96.5%（19，570人中的18，890人）。在接受抗逆转录病毒疗法的婴儿中，多胞胎的比例（26.4%）高于总出生人口中所有出生婴儿的比例（3.4%）。大约25.5%的ART受孕婴儿是双胞胎，0.9%是三胞胎和更高顺序的婴儿。在全国范围内，接受抗逆转录病毒疗法的婴儿占所有低出生体重（<2 500 g）婴儿的4.5%。在ART受孕的婴儿中，20.2%的婴儿出生体重低，而在所有婴儿中为8.3%。ART受孕的婴儿占所有早产儿（胎龄<37周）的5.3%。接受抗逆转录病毒疗法的婴儿早产率（27.8%）高于总出生人口中出生的所有婴儿的早产率（9.9%）。单胎低出生体重的百分比在ART受孕的婴儿中为8.1%，在所有出生的婴儿中为6.6%。ART受孕的单胎婴儿的早产率为14.0%，而所有单胎婴儿的早产率为8.1%。在ART妊娠的婴儿中，小于胎龄儿的百分比为7.6%，而在所有婴儿中为9.9%。虽然单胎婴儿占ART受孕婴儿的大多数，但ART的多胞胎仍然占美国出生的所有双胞胎，三胞胎和更高级别婴儿的很大比例。注意到各州和地区之间SET率的差异，反映了生育诊所之间胚胎移植实践的差异，这可能部分解释了在一些州和地区观察到的ART的多胎分娩。在临床上适当的情况下，减少胚胎移植的数量和增加SET的使用，可以帮助减少多胎分娩和对母亲和婴儿的相关不良健康后果。由于多胞胎婴儿的许多不良后遗症的风险增加，不能确定通过单独的NASS收集的数据，长期随访ART婴儿通过整合现有的孕产妇和婴儿健康监测系统和登记与NASS提供的数据可能是有用的监测不良后果的人口基础上。
Since the first U.S. infant conceived with assisted reproductive technology (ART) was born in 1981, both the use of ART and the number of fertility clinics providing ART services have increased steadily in the United States. ART includes fertility treatments in which eggs or embryos are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Although the majority of infants conceived through ART are singletons, women who undergo ART procedures are more likely than women who conceive naturally to have multiple-birth infants because multiple embryos may be transferred. Multiple births can pose substantial risks for both mothers and infants, including obstetric complications, preterm birth (<37 weeks), and low birthweight (<2,500 g). This report provides state-specific information for the United States (including the District of Columbia and Puerto Rico) on ART procedures performed in 2017 and compares birth outcomes that occurred in 2017 (resulting from ART procedures performed in 2016 and 2017) with outcomes for all infants born in the United States in 2017. 2017. In 1995, CDC began collecting data on ART procedures performed in fertility clinics in the United States as mandated by the Fertility Clinic Success Rate and Certification Act of 1992 (Public Law 102–493 [October 24, 1992]). Data are collected through the National ART Surveillance System (NASS), a web-based data collection system developed by CDC. This report includes data from the 50 states, the District of Columbia, and Puerto Rico. In 2017, a total of 196,454 ART procedures (range: 162 in Alaska to 24,179 in California) with at least one embryo transferred were performed in 448 U.S. fertility clinics and reported to CDC. These procedures resulted in 68,908 live-birth deliveries (range: 67 in Puerto Rico to 8,852 in California) and 78,052 infants born (range: 85 in Puerto Rico to 9,926 in California). Nationally, the number of ART procedures performed per 1 million women of reproductive age (15–44 years) was 3,040. ART use rates exceeded the national rate in 14 states (Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Utah, Vermont, and Virginia). ART use exceeded 1.5 times the national rate in seven states (Connecticut, the District of Columbia, Illinois, Maryland, Massachusetts, New Jersey, and New York). Nationally, among all ART transfer procedures, the average number of embryos transferred increased slightly with increasing age (1.3 among women aged <35 years, 1.4 among women aged 35–37 years, and 1.5 among women aged >37 years). This year, single-embryo transfer (SET) rates among all embryo-transfer procedures are presented instead of elective single-embryo transfer procedures previously reported. Nationally, SET rates were 67.3% (range: 38.9% in South Dakota to 90.4% in Delaware), 65.0% (range: 23.6% in Puerto Rico to 89.4% in Delaware), and 60.0% (range: 28.6% in Puerto Rico to 83.1% in Delaware) among women aged <35 years, aged 35–37 years, and aged >37 years, respectively. In 2017, ART contributed to 1.9% of all infants born in the United States (range: 0.4% in Puerto Rico to 5.0% in Massachusetts). Approximately 73.6% of ART-conceived infants were singleton infants. Overall, ART contributed to 14.7% of all multiple births, including 14.7% of all twin infants and 17.3% of all triplets and higher-order infants. ART-conceived twins accounted for approximately 96.5% (18,890 of 19,570) of all ART-conceived infants born in multiple deliveries. The percentage of multiple births was higher among infants conceived with ART (26.4%) than among all infants born in the total birth population (3.4%). Approximately 25.5% of ART-conceived infants were twins, and 0.9% were triplets and higher-order infants. Nationally, infants conceived with ART contributed to 4.5% of all low birthweight (<2,500 g) infants. Among ART-conceived infants, 20.2% had low birthweight, compared with 8.3% among all infants. ART-conceived infants contributed to 5.3% of all preterm (gestational age <37 weeks) infants. The percentage of preterm births was higher among infants conceived with ART (27.8%) than among all infants born in the total birth population (9.9%). The percentage of low birthweight among singletons was 8.1% among ART-conceived infants and 6.6% among all infants born. The percentage of preterm births among ART-conceived singleton infants was 14.0%, compared with 8.1% among all singleton infants. The percentages of small for gestational age infants was 7.6% among ART-conceived infants, compared with 9.9% among all infants. Although singleton infants accounted for the majority of ART-conceived infants, multiple births from ART still contributed to a substantial proportion of all twins, triplets, and higher-order infants born in the United States. Variations in SET rates among states and territories were noted, reflecting variations in embryo-transfer practices among fertility clinics, which might in part account for higher multiple birth from ART observed in some states and territories. Reducing the number of embryos transferred and increasing use of SET, when clinically appropriate, can help reduce multiple births and related adverse health consequences for both mothers and infants. Because infants from multiple births are at increased risk for numerous adverse sequelae that cannot be ascertained from the data collected through NASS alone, long-term follow-up for ART infants through integration of existing maternal and infant health surveillance systems and registries with data available from NASS might be useful for monitoring adverse outcomes on a population basis.
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影响因子：
6.7
作者：
Boulet SL;Crawford S;Zhang Y;Sunderam S;Cohen B;Bernson D;McKane P;Bailey MA;Jamieson DJ;Kissin DM;States Monitoring ART Collaborative
通讯作者：
States Monitoring ART Collaborative
影响因子：
2.1
作者：
Hamilton, Barton H.;Mcmanus, Brian
通讯作者：
Mcmanus, Brian
影响因子：
6.7
作者：
Hope, Nicole;Rombauts, Luk
通讯作者：
Rombauts, Luk
影响因子：
3.3
作者：
Barradas, Danielle T.;Barfield, Wanda D.;Schieve, Laura A.
通讯作者：
Schieve, Laura A.
影响因子：
6.3
作者：
Dawson, April L.;Tinker, Sarah C.;Reefhuis, Jennita
通讯作者：
Reefhuis, Jennita