ART助孕患者与自然妊娠患者单胎母婴围生期结局的比较

发布时间：2018-02-02 22:50

本文关键词： 辅助生殖技术自然妊娠围生期结局胎盘　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：1978年,世界上第一例试管婴儿的诞生,标志着生殖医学发展史的里程碑。目前人类辅助生殖技术(Assisted reproductive technology,ART)出生新生儿占其总数1%~4%,数量已超过500万[1]。多项研究证实,ART助孕与自然妊娠对比,ART助孕技术增加患者母婴围生期不良妊娠结局,但部分研究显示ART的不良母婴围生期结局与母体不孕因素相关,目前仍存在争议。胎盘作为胎儿和母体进行物质交换的重要场所,其微血管网络的生成及循环建立是母、儿物质交换的保障,对于正常妊娠的维持有重要意义。最新研究表明,ART技术显著影响人与动物的宫内生长轨迹,胎盘功能对胎儿宫内生长发育及其出生后健康状态密切相关,而ART技术对胎盘功能的影响备受关注。目的评价ART助孕患者的母婴围生期结局,探讨ART技术对不同年龄阶段助孕患者母婴围生期结局和胎盘功能中的影响。资料与方法1.研究对象:选取我院2012年1月~2016年1月在郑州大学第三附属医院产科分娩的ART助孕患者925例;按1:3配对及时间匹配方式随机抽取我院自然妊娠(Spontaneous conception pregnancy,SC)分娩患者2935例作为对照组。2.研究方法:回顾性队列分析。比较两组间母体年龄,初潮年龄、孕产次、孕期体质量增加、分娩孕周等基线数据;比较两组间母婴围生期结局及胎盘效率间的差异。进一步,根据年龄进行分层,将两组分为年龄35岁组和年龄≥35岁组,比较不同年龄组上述母基线数据及婴围生期结局间的差异,进一步探讨ART技术对不同年龄阶段助孕患者母婴围生期结局的影响。3.统计学方法:采用SPSS 21.0统计软件进行统计学分析,计量资料采用(?)±s表示,计数资料采用百分率描述;计量资料两组比较采用两独立样本t检验,计数资料两组比较实用χ2检验或连续性校正,相关因素分析采用二分类Logistic分析。P0.05为差异有统计学意义。结果1.母体基线数据比较:两组患者年龄、高龄初产比率、瘢痕子宫发生率、孕产次、分娩方式及分娩孕周等差异有统计学意义(P0.05)。两组初潮年龄、孕期体质量增加等方面无统计学差异(P≥0.05),将瘢痕子宫发生率纳入孕产次行二分类Logstic分析后[aOR:1.122,95%CI(0.839-1.499)],两组间差异无统计学意义(P≥0.05)。2.母体围生期结局比较:将年龄和孕产次纳入二分类Logstic分析显示,两组间在前置胎盘发生率中ART组(5.0%)高于自然妊娠组(3.9%)[P=0.023,aOR:0.646,95%CI(0.443-0.942)];余两组间妊娠期并发症及合并症如:妊娠期高血压疾病、妊娠期糖尿病(GDM)、妊娠期胆汁淤积症(ICP)、产后出血,妊娠合并甲状腺功能异常、妊娠合并贫血、妊娠合并B组链球菌感染;两组间羊水及胎膜疾病等差异均无统计学意义(P≥0.05)。3.胎儿发育、新生儿情况及胎盘效率比较:ART组新生儿重度窒息发生率(6.7%vs 2.3%)和新生儿出生缺陷率(1.7%vs 0.5%)较自然妊娠组高,差异有统计学意义(P0.05);ART组胎盘重量(590.44±96.77 g)高于自然妊娠组(577.17±90.81 g),而胎盘效率低于自然妊娠组,差异均有统计学意义(P0.05)。余ART组与自然妊娠组在胎儿宫内生长受限(FGR)、新生儿性别比、新生儿体质量、新生儿身长及新生儿死亡率等方面均无统计学差异(P≥0.05)。4.按年龄分层后,各年龄组母体基线数据及围生期结局比较:(1)年龄35岁组:ART组年龄高于自然妊娠组,分娩孕周小于自然妊娠组,差异有统计学意义(P0.05);经年龄,孕产次校正后,两组间各种母婴围生期结局,两组间差异均无统计学意义(P≥0.05);ART组新生儿平均出生体质量较低,新生儿重度窒息率及新生儿出生缺陷等发生率高于自然妊娠组,而胎盘效率低于自然妊娠组,差异均有统计学意义(P0.05);(2)年龄≥35岁组:两组在年龄、分娩孕周及孕期体质量增加等发面差异无统计学意义(P≥0.05);ART组在羊水过少和前置胎盘发生率,及新生儿体质量和胎盘重量均较自然妊娠组高,差异有统计学意义(P0.05),余两组间母体年龄和母婴围生期结局,差异均无统计学意义(P≥0.05)。结论1.ART助孕技术对母婴围生期结局相对安全。2.ART助孕技术影响胎盘效率。3.随着年龄增加,母体年龄对母婴围生期结局的影响显著。
[Abstract]:In 1978, the birth of the world's first test tube baby, marking the history of milepost in reproductive medicine. At present, human assisted reproductive technology (Assisted reproductive technology, ART) of newborn, accounting for the total number of 1%~4%, the number has more than 5 million [1]. a number of studies have confirmed that ART help pregnant and spontaneous pregnancy comparison, ART assisted reproductive technology patients increase maternal Wai period of adverse pregnancy outcomes, but some studies have shown that ART of maternal adverse perinatal outcomes and maternal factors related to infertility, it is still controversial. As an important place of placenta fetal and maternal material exchange, generation and circulation microvascular network establishment is the mother, son of material exchange security is important in maintaining normal pregnancy. The latest research shows that ART technology significantly affect human and animal intrauterine growth trajectory, health function of placenta on fetal growth and postnatal development States are closely related, and the effects of ART technology on placental function concern. Objective to evaluate the ART help pregnant patients with maternal and perinatal outcomes, discusses the ART technology in different age stages of pregnancy with maternal effect of perinatal outcome and placental function. Materials and methods: 1. subjects were selected in our hospital during January 2012 ~2016 in January 925 cases of ART patients with progesterone Third Affiliated Hospital of Zhengzhou University Department of Obstetrics; according to 1:3 matching and matching time in our hospital were randomly selected (Spontaneous conception pregnancy, the natural pregnancy childbirth SC) patients 2935 cases as control group.2. methods: retrospective cohort analysis. Comparison between the two groups of maternal age, menarche age, gravidity during pregnancy, increased body weight, gestational age and baseline data; perinatal differences between maternal outcome and placental efficiency were compared between the two groups. Further, stratified according to age, the two group was divided into 35 years of age Group and 35 years of age or older were compared in different age groups the mother and infant baseline data of perinatal period outcome differences, to further explore the effect of ART technology on.3. statistical methods in different age stages of pregnancy with maternal perinatal outcome: statistical analysis was performed using SPSS 21 statistical software, measurement data using (?). S said the count data were described by percentage; the measurement data between the two groups using two independent samples t test, count data between the two groups of practical 2 test or continuity correction, correlation analysis using two classification Logistic analysis.P0.05 the difference was statistically significant. Results 1. maternal baseline data comparison: two groups of patients with age, elderly primipara the ratio of incidence of uterine scar pregnancy, mode of delivery and the statistically significant differences in gestational age (P0.05). The two groups had no significant difference on age at menarche, pregnancy weight gain (P = 0.05), the incidence of uterine scar pregnancy into the two category Logstic analysis [aOR:1.122,95%CI (0.839-1.499)], there was no significant difference between the two groups (P = 0.05).2. maternal perinatal outcome comparison: age and parity into the two category Logstic analysis showed that among the two groups in the incidence of placenta previa. The ART group (5%) was higher than that of natural pregnancy group (3.9% [P=0.023), aOR:0.646,95%CI (0.443-0.942)]; two groups of pregnancy complications such as gestational hypertension, gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), postpartum hemorrhage, thyroid dysfunction during pregnancy, pregnant women with anemia group B streptococcal infection in pregnancy, amniotic fluid and fetal membranes; differences in disease between the two groups were not statistically significant (P = 0.05).3. fetal development, comparison and placental efficiency: the incidence of neonatal severe neonatal asphyxia ART group (6.7%vs 2.3%) and new Birth defect rate (1.7%vs 0.5%) were higher than that of natural pregnancy group, the difference was statistically significant (P0.05); group ART, placental weight (590.44 + 96.77 g) is higher than that of natural pregnancy group (577.17 + 90.81 g), and the placental efficiency is lower than the natural pregnancy group, the differences were statistically significant (P0.05). More than ART group the natural pregnancy group in intrauterine growth restriction (FGR), the sex ratio at birth, neonatal body mass, there was no significant difference on neonatal length and neonatal mortality (P = 0.05).4. stratified by age, baseline data among different age groups of maternal and perinatal outcomes: (1) 35 years old age group: ART the age group is higher than the natural pregnancy group, gestational age less than natural pregnancy group, the difference was statistically significant (P0.05); the age, parity between the two groups after the correction, a variety of maternal and perinatal outcomes, differences between the two groups had no statistical significance (P = 0.05); group ART newborn physique The amount is low, the incidence is higher than the natural rate of pregnancy group and birth defects of severe neonatal asphyxia, and placental efficiency is lower than the natural pregnancy group, the differences were statistically significant (P0.05); (2) 35 years of age or older group: the two groups in age, gestational age and maternal body weight increased from the aspects of no statistical difference significance (P = 0.05); group ART in oligohydramnios and incidence of placenta previa, body weight and placenta weight and neonatal were natural pregnancy group, the difference was statistically significant between the two groups (P0.05), maternal age and maternal and perinatal outcomes, there were no significant differences (P = 0.05). 1.ART assisted reproductive technology on maternal and perinatal outcomes relative to affect the safety of assisted reproductive technology.2.ART placental efficiency of.3. increased with age, the maternal age effect on maternal and perinatal outcome significantly.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8

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