Uterine artery Doppler in singleton pregnancies conceived afterin-vitrofertilization or intracytoplasmic sperm injection with freshvsfrozen blastocyst transfer: longitudinal cohort study
Uterine artery Doppler in singleton pregnancies conceived afterin-vitrofertilization or intracytoplasmic sperm injection with freshvsfrozen blastocyst transfer: longitudinal cohort study
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DOI：
10.1002/uog.21969
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发表时间：
2020-09-11
影响因子：
7.1
通讯作者：
Candiani, M.
中科院分区：
文献类型：
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作者：
Cavoretto, P. I.;Farina, A.;Candiani, M.
目的 与新鲜囊胚移植的妊娠相比，冷冻囊胚移植 (FBT) 妊娠的胎龄和出生体重更高。本研究的目的是评估使用新鲜与冷冻保存的囊胚通过体外受精 (IVF) 或胞浆内单精子注射 (ICSI) 技术受孕的子宫动脉搏动指数 (UtA-PI)。方法 这是一项针对 FBT 或新鲜囊胚移植后受孕的可行单胎 IVF/ICSI 妊娠的前瞻性纵向研究，这些妊娠在 7-37 孕周时在意大利米兰圣拉斐尔医院接受了系列超声评估。我们排除了使用其他辅助生殖技术受孕的妊娠，例如捐卵、双胞胎妊娠、异常妊娠和导致流产的妊娠。孕妇在妊娠 7-10、11-14、18-25 和 26-37 周时接受超声评估。根据胎儿医学基金会标准，使用多普勒超声测量平均 UtA-PI。记录妊娠结果。主要结局是平均 UtA-PI 测量，次要结局是出生胎龄、出生体重以及胎儿和母亲并发症，包括小于胎龄 (SGA)、先兆子痫和大于胎龄。 UtA-PI值经过log(10)变换后变为高斯分布。使用多级线性混合模型（固定效应和随机效应）对重复测量进行分析。还评估了其他协变量对 UtA-PI 多普勒值的可能影响，包括体重指数、SGA 和先兆子痫。结果 共纳入 367 个 IVF/ICSI 周期，其中 164 个采用新鲜囊胚移植，203 个采用 FBT，总共收集和分析了 625 个观察结果（中位数为 2.5（范围为 1-4））。与新鲜囊胚移植组相比，FBT 组的 UtA-PI 平均降低 14%。无论研究组如何，在有 SGA 胎儿的妊娠中，UtA-PI 比没有 SGA 胎儿的妊娠高 18%。与接受FBT的妊娠相比，接受新鲜囊胚移植的妊娠的出生体重百分位显着较低（43.4 +/- 23.3vs50.0 +/- 23.1；P = 0.007），并且SGA率较高（7.9%vs2.0%；P = 0.008）。两组之间的出生胎龄以及早产、先兆子痫、妊娠糖尿病和大于胎龄的发生率没有显着差异。结论 与新鲜囊胚移植相比，FBT 后 IVF/ICSI 妊娠中的 UtA-PI 和 SGA 比例较低。版权所有 (c) 2020 ISUOG。由约翰·威利父子有限公司出版
Objective Pregnancies conceived by frozen blastocyst transfer (FBT) have higher gestational age and weight at birth as compared to those derived by fresh blastocyst transfer. The aim of this study was to evaluate uterine artery pulsatility index (UtA-PI) in pregnancies conceived byin-vitrofertilization (IVF) or intracytoplasmic sperm injection (ICSI) techniques using freshvscryopreserved blastocysts. Methods This was a prospective longitudinal study of viable singleton IVF/ICSI pregnancies conceived after FBT or fresh blastocyst transfer, that underwent serial ultrasound assessment at San Raffaele Hospital, Milan, Italy at 7-37 gestational weeks. We excluded pregnancies conceived using other assisted reproductive techniques such as egg donation, twin gestation, pregnancy with abnormality and those resulting in miscarriage. Pregnant women underwent ultrasound assessment at 7-10, 11-14, 18-25 and 26-37 weeks' gestation. Mean UtA-PI was measured using Doppler ultrasound according to The Fetal Medicine Foundation criteria. Pregnancy outcomes were recorded. The primary outcome was mean UtA-PI measurement and secondary outcomes were gestational age at birth, birth weight and fetal and maternal complications, including small-for-gestational age (SGA), pre-eclampsia and large-for-gestational age. UtA-PI values were made Gaussian after log(10)transformation. Analysis of repeated measures using a multilevel linear mixed model (fixed effects and random effects) was performed. The possible effect of other covariates on UtA-PI Doppler values, including body mass index, SGA and pre-eclampsia, was also evaluated. Results A total of 367 IVF/ICSI cycles, comprising 164 with fresh blastocyst transfer and 203 with FBT, were included and a total of 625 observations (median, 2.5 (range, 1-4)) were collected and analyzed. The FBT group had on average 14% lower UtA-PI compared with the fresh-blastocyst-transfer group. In pregnancies with SGA fetuses, UtA-PI was 18% higher compared to pregnancies without, irrespective of the study group. Pregnancies that underwent fresh blastocyst transfer had significantly lower birth-weight centile (43.4 +/- 23.3vs50.0 +/- 23.1;P = 0.007) and a higher rate of SGA (7.9%vs2.0%;P = 0.008) compared to those that underwent FBT. No significant differences were found between the two groups with respect to gestational age at birth and rates of preterm birth, pre-eclampsia, gestational diabetes mellitus and large-for-gestational age. Conclusion UtA-PI and the proportion of SGA are lower in IVF/ICSI pregnancies conceived after FBT as compared to fresh blastocyst transfer. Copyright (c) 2020 ISUOG. Published by John Wiley & Sons Ltd.