試管嬰兒IVF / ICSI治療後單胞胎妊娠其產科的結果:系統性回顧和綜合分析

出處:第一名的不孕症期刊 Hum Reprod Update.

 

May 19, 2012搶鮮版

 

來自英國的研究

 

 

 

 

試管嬰兒IVF / ICSI治療後單胞胎妊娠其產科的結果:系統性回顧和綜合分析

 

背景

早些時候評論IVF / ICSI治療的懷孕有較高的風險相關建議。然而,最新進展,在做IVF / ICSI治療的方式,導致體外受精/ ICSI的單胞胎妊娠是否具有較高的周產期風險相關的一些爭議。本系統研究的目的是比較IVF / ICSI治療後出生的與自然受孕出生的單胞胎產科的結果。

目的

由兩位作者進行了廣泛的搜索方法。該協議同意先驗。其次PRISMA的指導。在2×2表中提取數據。使用匯集的數據,計算風險率和風險差異。質量評估研究進行批判性評價技能方案。進行敏感性分析時異質性高。

結果

20匹配的隊列研究,包括在本次審查的10個非隊列研究。IVF / ICSI治療較自然受孕出生的單胞胎單胎妊娠的風險較高,包括(95%信賴區間)的產前出血(2.492.30-2.69),先天性畸形(1.671.33-2.09),妊娠高血壓疾病(1.491.39-1.59 ),早產胎膜早破(1.161.07-1.26),剖腹產(1.561.51-1.60),低出生體重(1.651.56-1.75),周產兒死亡率(1.871.48-2.37),早產(1.541.47 -1.62),妊娠糖尿病(1.481.33-1.66),引產(1.181.10-1.28)和胎齡小(1.391.27-1.53)。

結論

與自然受孕相比,相關結論顯示IVF / ICSI治療後單胞胎妊娠產科和周產期併發症的風險較高。還需要進一步研究,以確定這方面的輔助生殖技術帶來最危險和如何可以盡量減少這種風險。

 

 

Human Reproduction Update, Vol.18, No.5 pp. 485503, 2012

Advanced Access publication on May 19, 2012 doi:10.1093/humupd/dms018

Obstetric and perinatal outcomes in singleton pregnancies resulting from

IVF/ICSI: a systematic review and meta-analysis

Shilpi Pandey1, Ashalatha Shetty2, Mark Hamilton1,

Siladitya Bhattacharya3, and Abha Maheshwari3,*

1Assisted Reproduction Unit, Aberdeen Maternity Hospital , Aberdeen AB25 2ZL , UK 2Aberdeen Maternity Hospital , Aberdeen AB25 2ZL,

UK 3Division of Applied Health Sciences, University of Aberdeen , Aberdeen Maternity Hospital , Aberdeen AB25 2ZL , UK

*Correspondence address. E-mail: abha.maheshwari@abdn.ac.uk

Submitted on February 3, 2012; resubmitted on March 30, 2012; accepted on April 14, 2012

BACKGROUND Earlier reviews have suggested that IVF/ICSI pregnancies are associated with higher risks. However, there have been recent advances in the way IVF/ICSI is done, leading to some controversy as to whether IVF/ICSI singletons are associated with higher perinatal risks. The objective of this systematic review was to provide an up-to-date comparison of obstetric and perinatal outcomes of the singletons born after IVF/ICSI and compare them with those of spontaneous conceptions. METHODS Extensive searches were done by two authors. The protocol was agreed a priori. PRISMA guidance was followed. The data were extracted in 2 × 2 tables. Risk ratio and risk difference were calculated on pooled data using Rev Man 5.1. Quality assessment of studies was performed using Critical Appraisal Skills programme. Sensitivity analysis was performed when the heterogeneity was high (I(2) > 50%). RESULTS There were 20 matched cohort studies and 10 unmatched cohort studies included in this review. IVF/ICSI singleton pregnancies were associated with a higher risk (95% confidence interval) of ante-partum haemorrhage (2.49, 2.30-2.69), congenital anomalies (1.67, 1.33-2.09), hypertensive disorders of pregnancy (1.49, 1.39-1.59), preterm rupture of membranes (1.16, 1.07-1.26), Caesarean section (1.56, 1.51-1.60), low birthweight (1.65, 1.56-1.75), perinatal mortality (1.87, 1.48-2.37), preterm delivery (1.54, 1.47-1.62), gestational diabetes (1.48, 1.33-1.66), induction of labour (1.18, 1.10-1.28) and small for gestational age (1.39, 1.27-1.53). CONCLUSIONS Singletons pregnancies after IVF/ICSI are associated with higher risks of obstetric and perinatal complications when compared with spontaneous conception. Further research is needed to determine which aspect of assisted reproduction technology poses most risk and how this risk can be minimized.



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