体外受精-胚胎移植术后妊娠早产风险的相关分析

doi:10.3760/cma.j.cn441417-20250527-22007

摘要/Abstract

摘要： 目的　分析体外受精-胚胎移植（IVF-ET）术后妊娠早产的高危因素及早产儿结局。方法　回顾性分析，收集2018年1月至2023年12月陆军第七十三集团军医院治疗的742例早产患者资料，根据纳排标准，将所有早产患者按照受孕方式及妊娠胚胎数分为4组：IVF-ET术后妊娠单胎组（257例）、IVF-ET术后妊娠双胎组（161例）、自然妊娠单胎组（283例）、自然妊娠双胎组（41例）。IVF-ET妊娠早产组年龄（32.53±4.30）岁，分娩孕周（34.59±2.20）周；自然妊娠早产组年龄（32.35±3.60）岁，分娩孕周（35.20±1.58）周。分析4组孕妇的一般情况（年龄、分娩孕周、产次）、妊娠并发症及合并症、分娩方式及早产儿结局。统计学方法采用t检验、χ²检验或Fisher精确概率法。结果　IVF-ET妊娠早产组高龄、初产率均高于自然妊娠早产组［23.92%（100/418）比17.90%（58/324）、84.92%（355/418）比45.06%（146/324）］，分娩孕周低于自然妊娠早产组［（34.59±2.20）周比（35.20±1.58）周］，差异均有统计学意义（均P<0.05）。IVF-ET术后妊娠单胎组宫颈机能不全、胎盘异常、妊娠期糖尿病、妊娠期贫血、剖宫产、新生儿窒息率均高于自然妊娠单胎组［3.50%（9/257）比0.71%（2/283）、22.57%（58/257）比14.13%（40/283）、33.85%（87/257）比25.08%（71/283）、15.18%（39/257）比9.54%（27/283）、60.31%（155/257）比42.40%（120/283）、7.39%（19/257）比2.12%（6/283）］，差异均有统计学意义（均P<0.05）。IVF-ET术后妊娠双胎组妊娠期糖尿病、妊娠期高血压、剖宫产、产后出血、转新生儿重症监护病房率均高于自然妊娠双胎组［34.78%（56/161）比12.19%（5/41）、32.91%（53/161）比17.07%（7/41）、87.57%（141/161）比53.65%（22/41）、21.73%（35/161）比7.32%（3/41）、85.71%（138/161）比58.54%（24/41）］，差异均有统计学意义（均P<0.05）。结论　IVF-ET术双胎的平均孕周较低，妊娠期并发症及合并症发生率增高，剖宫产率上升，建议控制IVF-ET术的医源性并发症，评估单双胎的移植风险及数量，提倡单囊胚移植。妊娠期并发症可导致早产发生，加强对IVF-ET术后妊娠患者的宣教及孕期管理，避免妊娠期并发症的发生，降低早产风险，改善母婴结局。

关键词: 早产, IVF-ET术后, 双胎妊娠, 妊娠并发症, 早产儿, 妊娠结局

Abstract: Objective　To analyze the high risk factors of premature delivery and the outcomes of premature infants after in vitro fertilization-embryo transfer (IVF-ET). Methods　A retrospective analysis was conducted to collect the data of 742 premature patients treated in the Army 73rd Group Military Hospital from January 2018 to December 2023. According to the inclusion and exclusion criteria, the premature patients were divided into four groups according to the modes of conception and the numbers of pregnant embryos: a IVF-ET pregnancy singleton group (257 cases), a IVF-ET pregnancy twin group (161 cases), a natural pregnancy singleton group (283 cases), and a natural pregnancy twin group (41 cases). The IVF-ET pregnancy premature delivery group was (32.53±4.30) years old, and the gestational age of delivery was (34.59±2.20) weeks; the natural pregnancy preterm group was (32.35±3.60) years old, and the gestational age was (35.20±1.58) weeks. The general conditions (age, gestational age, and parity), pregnancy complications and comorbidities, delivery methods, and premature birth outcomes of pregnant women in the four groups were analyzed. Statistical methods included t test, χ² test, or Fisher's exact test. Results　The advanced age and primary birth rate of the IVF-ET pregnancy preterm group were higher than those of the natural pregnancy preterm group [23.92% (100/418) vs. 17.90% (58/324) and 84.92% (355/418) vs. 45.06% (146/324)], and the gestational age lower [(34.59±2.20)weeks vs. (35.20±1.58)weeks], with statistical differences (all P<0.05). The rates of cervical insufficiency, placental abnormality, gestational diabetes mellitus, gestational anemia, cesarean section, and neonatal asphyxia in the singleton pregnancy group after IVF-ET were higher than those in the singleton natural pregnancy group [3.50% (9/257) vs. 0.71% (2/283), 22.57% (58/257) vs. 14.13% (40/283), 33.85% (87/257) vs. 25.08% (71/283), 15.18% (39/257) vs. 9.54% (27/283), 60.31% (155/257) vs. 42.40% (120/283), and 7.39% (19/257) vs. 2.12% (6/283)], with statistical differences (all P<0.05). The rates of gestational diabetes mellitus, gestational hypertension, cesarean section, postpartum hemorrhage, and neonatal intensive care unit in the twin pregnancy group after IVF-ET were higher than those in the natural twin pregnancy group [34.78% (56/161) vs. 12.19% (5/41), 32.91% (53/161) vs. 17.07% (7/41), 87.57% (141/161) vs. 53.65% (22/41), 21.73% (35/161) vs. 7.32% (3/41), and 85.71% (138/161) vs. 58.54% (24/41)], with statistical differences (all P<0.05). Conclusions　The average gestational age of twins in IVF-ET is lower; the incidence of pregnancy complications and complications is higher; the rate of cesarean section is higher. It is suggested to control the iatrogenic complications of IVF-ET, evaluate the risk and quantity of single and twin transplantation, and promote single blastocyst transfer. Pregnancy complications can lead to premature birth. Strengthening the education and management of pregnancy patients after IVF-ET can avoid the occurrence of pregnancy complications, reduce the risk of premature birth, and improve maternal and infant outcomes.

Key words: Premature delivery, After IVF-ET, Twin pregnancy, Pregnancy complications, Premature infants, Pregnancy outcome

汪文雁肖丽郑剑兰. 体外受精-胚胎移植术后妊娠早产风险的相关分析[J]. 国际医药卫生导报, 2025, 31(22): 3730-3736.

Wang Wenyan, Xiao Li, Zheng Jianlan. Correlation analysis on the risk of preterm birth after in vitro fertilization-embryo transfer[J]. International Medicine and Health Guidance News, 2025, 31(22): 3730-3736.

参考文献

[1] Szamatowicz M. Assisted reproductive technology in reproductive medicine - possibilities and limitations[J]. Ginekol Pol, 2016, 87(12):820-823. DOI: 10.5603/GP.2016.0095.
[2] Qin J, Liu X, Sheng X, et al. Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies[J]. Fertil Steril, 2016, 105(1):73-85.e1-e6. DOI: 10.1016/j.fertnstert.2015.09.007.
[3] Li J, Shen J, Zhang X, et al. Risk factors associated with preterm birth after IVF/ICSI[J]. Sci Rep, 2022, 12(1):7944. DOI: 10.1038/s41598-022-12149-w.
[4] Lei LL, Lan YL, Wang SY, et al. Perinatal complications and live-birth outcomes following assisted reproductive technology: a retrospective cohort study[J]. Chin Med J (Engl), 2019, 132(20):2408-2416. DOI: 10.1097/CM9.0000000000000484.
[5] Gorgui J, Sheehy O, Trasler J, et al. Medically assisted reproduction and the risk of preterm birth: a case-control study using data from the Quebec Pregnancy Cohort[J]. CMAJ Open, 2020, 8(1):E206-E213. DOI: 10.9778/cmajo.20190082.
[6] Luke B, Brown MB, Wantman E, et al. Risk of prematurity and infant morbidity and mortality by maternal fertility status and plurality[J]. J Assist Reprod Genet, 2019, 36(1):121-138. DOI: 10.1007/s10815-018-1333-z.
[7] Cavoretto P, Candiani M, Giorgione V, et al. Risk of spontaneous preterm birth in singleton pregnancies conceived after IVF/ICSI treatment: meta-analysis of cohort studies[J]. Ultrasound Obstet Gynecol, 2018, 51(1):43-53. DOI: 10.1002/uog.18930.
[8] 刘騱遥,漆洪波. 辅助生育技术妊娠早产的防治[J]. 中华产科急救电子杂志,2019,8(3):133-136. DOI:10.3877/cma.j.issn.2095-3259.2019.03.002.
[9] Saccone G, Perriera L, Berghella V. Prior uterine evacuation of pregnancy as independent risk factor for preterm birth: a systematic review and metaanalysis[J]. Am J Obstet Gynecol, 2016, 214(5):572-591. DOI: 10.1016/j.ajog.2015.12.044.
[10] Stanhiser J, Steiner AZ. Psychosocial Aspects of Fertility and Assisted Reproductive Technology[J]. Obstet Gynecol Clin North Am, 2018, 45(3):563-574. DOI: 10.1016/j.ogc.2018.04.006.
[11] Bai F, Wang DY, Fan YJ, et al. Assisted reproductive technology service availability, efficacy and safety in mainland China: 2016. Hum Reprod[J]. 2020, 35(2):446-452. DOI: 10.1093/humrep/dez245.
[12] Vogel JP, Chawanpaiboon S, Moller AB, et al. The global epidemiology of preterm birth[J]. Best Pract Res Clin Obstet Gynaecol, 2018, 52:3-12. DOI: 10.1016/j.bpobgyn.2018.04.003.
[13] Okby R, Harlev A, Sacks KN, et al. Preeclampsia acts differently in in vitro fertilization versus spontaneous twins[J]. Arch Gynecol Obstet, 2018, 297(3):653-658. DOI: 10.1007/s00404-017-4635-y.
[14] Jiang F, Gao J, He J, et al. Obstetric outcomes for twins from different conception methods - a multicenter cross-sectional study from China[J]. Acta Obstet Gynecol Scand, 2021, 100(6):1061-1067. DOI: 10.1111/aogs.14116.
[15] da Silva SG, da Silveira MF, Bertoldi AD, et al. Maternal and child-health outcomes in pregnancies following Assisted Reproductive Technology (ART): a prospective cohort study[J]. BMC Pregnancy Childbirth, 2020, 20(1):106. DOI: 10.1186/s12884-020-2755-z.
[16] Brown R, Gagnon R, Delisle MF. No. 373-Cervical insufficiency and cervical cerclage[J]. J Obstet Gynaecol Can, 2019, 41(2):233-247. DOI: 10.1016/j.jogc.2018.08.009.
[17] 郭云蕾. 宫颈机能不全诊治上的困惑[J]. 国际生殖健康/计划生育杂志,2018,37(5):417-421. DOI:10.3969/j.issn.1674-1889.2018.05.017.
[18] 吴耀球,梁晓燕,杨星.行辅助生殖技术助孕后子宫颈机能不全患者妊娠结局及其晚期流产的高危因素分析[J].实用妇产科杂志,2020,36(4):280-284.
[19] Koullali B, Westervelt AR, Myers KM, et al. Prevention of preterm birth: novel interventions for the cervix[J]. Semin Perinatol, 2017, 41(8):505-510. DOI: 10.1053/j.semperi.2017.08.009.
[20] Sabban H, Zakhari A, Patenaude V, et al. Obstetrical and perinatal morbidity and mortality among in-vitro fertilization pregnancies: a population-based study[J]. Arch Gynecol Obstet, 2017, 296(1):107-113. DOI: 10.1007/s00404-017-4379-8.
[21] Li J, Shen J, Zhang X, et al. Risk factors associated with preterm birth after IVF/ICSI[J]. Sci Rep, 2022, 12(1):7944. DOI: 10.1038/s41598-022-12149-w.
[22] 马黔红. 辅助生殖技术与前置胎盘[J]. 实用妇产科杂志,2009,25(10):585-586. DOI:10.3969/j.issn.1003-6946.2009.10.006.
[23] Cheng ZH, Wei YM, Li HT, et al. Gestational diabetes mellitus as an effect modifier of the association of gestational weight gain with perinatal outcomes: a prospective cohort study in China[J]. Int J Environ Res Public Health, 2022, 19(9):5615. DOI: 10.3390/ijerph19095615.
[24] Lindsay KL, Brennan L, Kennelly MA, et al. Maternal metabolic response to dietary treatment for impaired glucose tolerance and gestational diabetes mellitus[J]. Ir J Med Sci, 2018, 187(3):701-708. DOI: 10.1007/s11845-018-1744-y.
[25] Sullivan-Pyke CS, Senapati S, Mainigi MA, et al. In Vitro fertilization and adverse obstetric and perinatal outcomes[J]. Semin Perinatol, 2017, 41(6):345-353. DOI: 10.1053/j.semperi.2017.07.001.
[26] Jie Z, Yiling D, Ling Y. Association of assisted reproductive technology with adverse pregnancy outcomes[J]. Iran J Reprod Med, 2015, 13(3):169-180.
[27] Pandey S, Shetty A, Hamilton M, et al. Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis[J]. Hum Reprod Update, 2012, 18(5):485-503. DOI: 10.1093/humupd/dms018.
[28] Zhu L, Zhang Y, Liu Y, et al. Maternal and live-birth outcomes of pregnancies following assisted reproductive technology: a retrospective cohort study[J]. Sci Rep, 2016, 6:35141. DOI: 10.1038/srep35141.
[29] Adu-Bonsaffoh K, Ntumy MY, Obed SA , et al. Perinatal outcomes of hypertensive disorders in pregnancy at a tertiary hospital in Ghana[J]. BMC Pregnancy Childbirth, 2017, 17(1):388. DOI: 10.1186/s12884-017-1575-2.
[30] Jauniaux E, Moffett A, Burton GJ. Placental implantation disorders[J]. Obstet Gynecol Clin North Am, 2020, 47(1):117-132. DOI: 10.1016/j.ogc.2019.10.002.