孕产妇发病率和医疗辅助生殖治疗类型
Alina Pelikh1, Ken R Smith, Mikko Myrskylä
1Centre for Longitudinal Studies, Social Research Institute, University College London, London, United Kingdom; Population Science, Huntsman Cancer Institute, the Department of Family and Consumer Studies, the Department of Obstetrics and Gynecology, and the Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City; Max Planck Institute for Demographic Research, Rostock, Germany; the Helsinki Institute for Demography and Population Health, University of Helsinki, Helsinki, Finland; and the Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Rostock, Germany and Helsinki, Finland.
医疗辅助生殖 (MAR) 治疗,特别是像辅助生殖技术 (ART) 这样的更具侵入性的治疗,与增加的孕产妇死亡率有关. 较少侵入性的MAR和生育药物在风险上没有显著差异.
科学领域:
- 生殖医学 生殖医学
- 孕产妇健康 孕产妇健康
- 产科 产科 产科 产科 产科
背景情况:
- 医疗辅助生殖 (MAR) 涵盖了克服不孕症的各种治疗方法.
- 了解与不同MAR方法相关的孕产妇发病风险对于患者咨询和护理至关重要.
- 之前的研究表明,MAR与母亲的不良结果之间存在联系,但根据治疗类型的具体风险需要进一步调查.
研究的目的:
- 为了比较不同受孕方式的孕产妇发病率,特别是比较提高生育能力的药物,子宫内授精 (IUI) 和辅助生殖技术 (ART) 与自身卵子或捐赠卵子,而不是无助孕.
- 调查MAR治疗的侵入性是否与孕产妇发病率的风险相关.
- 确定可能调解或混MAR和孕产妇死亡率之间的关系的因素.
主要方法:
- 一项回顾性队列研究利用犹他州2009-2017年出生证明数据 (N=469,919次分娩).
- 孕产妇发病率被定义为严重并发症的存在,包括输血,计划外科手术,ICU入院,黄昏症,子宫切除术或子宫破裂.
- 使用后勤回归模型来评估MAR (整体和治疗类型) 与孕产妇病率之间的关联,并根据社会人口统计学,先前存在的疾病,多胎妊娠和产科并发症进行调整.
主要成果:
- 通过MAR怀孕的孕妇表现出更高的孕妇发病率,随着治疗的侵入性增加,风险增加.
- 关联部分由多胎妊娠和产科并发症解释.
- 使用自身卵子细胞的辅助生殖技术 (ART) 仍然与较高的发病率相关 (OR 1.46). 然而,在单独分娩中,MAR组和无助怀孕之间的发病率差异在对产科并发病症进行控制后并不具有统计学意义.
结论:
- 更多的侵入性MAR治疗,包括ART和IUI,与增加的孕产妇发病率有关.
- 较少侵入性的MAR治疗方法与较高的孕产妇死亡率没有显著的关联.
- 虽然多胎妊娠和产科并发病症部分解释了观察到的关联,但低生育率本身可能是导致母亲患病率的独立因素.
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