JAMA Pediatr:试管婴儿的孩子出生缺陷更高?
MedSci · 2016/04/13
一项美国的研究报道指出,体外受精 (IVF) 或使用其它生殖技术的女性相比自然受孕的更容易发生后代出生缺陷。


一项美国的研究报道指出,体外受精 (IVF) 或使用其它生殖技术的女性相比自然受孕的更容易发生后代出生缺陷。

作者注意到这项发现将女性尝试这种方法的想法扼杀在了摇篮里。

他们指出并发症风险的增加至少部分是由于母体较老的年龄和其它健康因素导致女性试图将辅助生殖技术(APT)放在第一位考虑。

美国疾病控制和预防中心生殖健康卫生科学家Sheree Boulet医生领导了这项研究并指出:“这项研究并没有告诉接受ART后,婴儿出生缺陷风险增加背后的原因。我们的初稿认为原因可能与潜在的生育能力低下相关——导致很多夫妻选择ART,这可能会增加出生缺陷的风险。”

Boulet和她的同事回顾了佛罗里达州从2000年-2010年超过460万的婴儿数据。

4月4日发表在JAMA Pediatrics的报告指出,大约1.4%,粗略的说是65000个婴儿是辅助生殖技术获得的。整体上,每10000个婴儿,有59个使用ART的,至少有1个患者非染色体基因缺陷。大多数不使用ART的女性都小于30岁,接受辅助生殖技术的都至少35岁以上。

即使调整了年龄和其它健康特征后,经ART的婴儿比普通婴儿高出28%的可能性更容易发生出生缺陷。

在多胞胎中,直肠疾病和大肠闭锁/狭窄的风险较未接受ART的婴儿高2.3倍。接受新鲜胚胎移植的婴儿中,患有排卵障碍的女性婴儿出生缺陷的风险增加53%。

在一个接受辅助孵化的女性亚组中,有高出55%的出生缺陷风险。

作者指出,这项研究的缺陷是缺少妊娠产妇未活产婴儿的出生缺陷数据,意味着可能低估了出生缺陷的患病率。也有可能是经ART的婴儿会更加严密的监,导致这类婴儿出生缺陷的检出率更高。

达特茅斯大学医学院妇产科和病理学教授Geisel指出:“尽管这个研究发现了出生缺陷的风险差异,但需要注意的是整体的缺陷率的很低的。未参加此项研究的学者Stern指出,绝大部分ART的婴儿都是正常的。

相关阅读:

Reproductive Technology Tied to Higher Risk of Birth Defects

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  • Assisted Reproductive Technology and Birth Defects Among Liveborn Infants in Florida, Massachusetts, and Michigan, 2000-2010

    Importance Use of assisted reproductive technology (ART) has been associated with increased risks for birth defects. Variations in birth defect risks according to type of ART procedure have been noted, but findings are inconsistent. Objectives To examine the prevalence of birth defects among liveborn infants conceived with and without ART and to evaluate risks associated with certain ART procedures among ART-conceived infants. Design, Setting, and Participants Used linked ART surveillance, birth certificates, and birth defects registry data for 3 states (Florida, Massachusetts, and Michigan). Methods for ascertaining birth defect cases varied by state. Resident live births during 2000 to 2010 were included, and the analysis was conducted between Feburary 2015 and August 2015. Exposures Use of ART among all live births and use of certain ART procedures among ART births. Main Outcome and Measures Prevalence of selected chromosomal and nonchromosomal birth defects that are usually diagnosed at or immediately after birth. Results Of the 4 618 076 liveborn infants between 2000 and 2010, 64 861 (1.4%) were conceived using ART. Overall, the prevalence of 1 or more of the selected nonchromosomal defects was 58.59 per 10 000 for ART infants (n = 389) vs 47.50 per 10 000 for non-ART infants (n = 22 036). The association remained significant after adjusting for maternal characteristics and year of birth (adjusted risk ratio [aRR], 1.28; 95% CI, 1.15-1.42). Similar differences were observed for singleton ART births vs their non-ART counterparts (63.69 per 10 000 [n = 218] vs 47.17 per 10 000 [n = 21 251]; aRR, 1.38; 95% CI, 1.21-1.59). Among multiple births, the prevalence of rectal and large intestinal atresia/stenosis was higher for ART births compared with non-ART births (aRR, 2.39; 95% CI, 1.38-4.12). Among ART births conceived after fresh embryo transfer, infants born to mothers with ovulation disorders had a higher prevalence of nonchromosomal birth defects (aRR, 1.53; 95% CI, 1.13-2.06) than those born to mothers without the diagnosis, and use of assisted hatching was associated with birth defects among singleton births (aRR, 1.55; 95% CI, 1.10-2.19). Multiplicity-adjusted P values for these associations were greater than .05. Conclusions and Relevance Infants conceived after ART had a higher prevalence of certain birth defects. Assisted hatching and diagnosis of ovulation disorder were marginally associated with increased risks for nonchromosomal birth defects; however, these associations may be caused by other underlying factors. INTRODUCTION ABSTRACT | INTRODUCTION | METHODS | RESULTS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES In 2012, approximately 1.5% of liveborn infants in the United States were conceived using assisted reproductive technology (ART), defined as fertility treatments in which eggs or embryos are handled outside the body.1 Since the birth of the first ART-conceived infant in the United States in 1981, ART use has increased rapidly; more than 157 000 cycles were performed in 2012.2 Although ART is generally considered safe, findings from registry-based cohort studies3- 5 and meta-analyses,6- 8 primarily conducted in non-US populations, suggest that children conceived with ART have increased risks for birth defects compared with their spontaneously conceived counterparts, particularly among singleton infants. Information on the degree to which certain ART procedures influence the risk of birth defects is limited and often inconclusive. Results from a 2012 cohort study3 indicated that use of intracytoplasmic sperm injection (ICSI), a procedure in which a single sperm is injected directly into an egg, was associated with increased odds of birth defects relative to spontaneously conceived pregnancies, whereas no effect was noted for conventional in vitro fertilization (IVF) without ICSI. However, pooled risk estimates for the association between birth defects and conventional IVF vs those for the association between birth defects and ICSI have not been found to be markedly different.6,7 Similarly, while several studies comparing fresh and frozen-thawed embryo transfers identified similar risks for birth defects regardless of embryo state,5,9- 12 1 study found an increased prevalence of birth defects for fresh but not frozen embryo cycles when compared with spontaneously conceived births.3 In addition, results from another study indicated that the odds of blastogenesis defects were 3 times higher for ART births after fresh embryo transfer vs non-ART controls, while no effect was found for frozen-thawed embryo transfers.13 There is insufficient evidence to evaluate the risk of birth defects following the use of other ART procedures such as assisted hatching14,15 and donor oocytes16 or for embryo stage at transfer.17,18 Because both ART and birth defects are infrequent events, sufficiently powered studies are needed to evaluate associations, particularly with regard to specific ART procedures. Thus, the aim of our study was to use population-based data from 3 US states to assess the prevalence of birth defects among liveborn infants conceived using ART compared with their non-ART counterparts and to examine the risk of birth defects associated with different types of ART procedures among ART-conceived infants.

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