谢谢你。
妊娠前三个月接触皮质类固醇与泌尿生殖系统先天性异常的风险增加有关
塔卢里，V。
伍德曼，r.j.。
AU - Vollenhoven, B。
特雷姆伦，K。
AU - Zander-Fox, D。
版权所有:©作者(s) 2022。牛津大学出版社代表欧洲人类生殖与胚胎学会出版。版权所有。有关许可，请发送电子邮件:journals.permissions@oup.com。
Py - 2022/8/25
Y1 - 2022/8/25
研究问题:母体在IVF/ICSI治疗中妊娠早期接触皮质类固醇是否会导致先天性异常的风险增加?结论:在IVF/ICSI辅助下出生的婴儿，其母亲在妊娠早期接受辅助皮质类固醇治疗，其患隐睾、尿道下裂和足底裂的风险增加。已知情况:母亲接触皮质类固醇可能会增加先天性异常的风险，如腭裂和神经管缺陷。然而，现有的研究结果相互矛盾，研究力度不足，并且没有研究接受体外受精/ICSI的人群，这一人群已知存在异常风险增加。研究设计、规模、持续时间:这项回顾性队列分析涵盖了澳大利亚墨尔本的莫纳什IVF生育诊所，评估了2010年至2016年间新鲜和冷冻胚胎移植的12426例活产婴儿的结果。参与者/材料、环境、方法:我们的研究组中有618例活产婴儿，这些母亲在IVF/ICSI治疗期间暴露于皮质类固醇(口服强的松龙或地塞米松)，其余婴儿未暴露于类固醇(对照组，n = 11,808)。测量的主要结果是先天性异常的存在，次要结果是出生体重和妊娠长度。采用多变量二元logistic回归来评估皮质类固醇暴露和胚胎冷冻的独立影响，并调整母亲取卵时的年龄、吸烟状况、服药周期数、BMI、不孕症的病因和ICSI的使用。结果以95% ci的发生率比(IRRs)表示。主要结果和偶然性的作用:在12 426例活产和597例出生缺陷中，多因素logistic回归显示马蹄内翻发生率增加(1.33% vs 0.32%，校正IRR = 4.30, 95% CI = 1.93, 9.58; P < 0.001), hypospadias (0.66% vs 0.18%, adjusted IRR = 5.90, 95% CI = 2.09, 16.69; P = 0.001) and cryptorchidism (0.83% vs 0.19%, adjusted IRR = 5.53, 95% CI = 1.91, 15.42; P = 0.001) in the offspring of mothers exposed to corticosteroids compared to those who were unexposed. The incidence of neither neural tube defects nor cleft palate were significantly increased in babies exposed to corticosteroids. The sex ratio of infants exposed to corticosteroids during a fresh embryo transfer cycle significantly favored males but reverted to the normal sex ratio in infants conceived in frozen embryo transfer cycles. LIMITATIONS, REASONS FOR CAUTION: This was a retrospective observational cohort study using administrative datasets with the potential for measurement error and unobserved confounding. Missing outcome data were obtained from patients using self-report leading to possible ascertainment bias. Given the rare incidence of some of the anomalies assessed, the study was underpowered to identify differences in abnormality rates for some specific anomalies. WIDER IMPLICATIONS OF THE FINDINGS: The findings of this study, the largest of its kind, suggest that caution should be heeded when prescribing corticosteroids to women undergoing IVF/ICSI, given that this study has now identified three previously unassociated serious neonatal complications (talipes, hypospadias and cryptorchidism), plus a potential alteration in sex ratio. Physicians should be careful in using corticosteroids in the critical first trimester and should counsel patients regarding the potential risks of this treatment. STUDY FUNDING/COMPETING INTEREST(S): There was no funding sought or obtained for this study. K.T., V.T., B.V. and D.Z.-F. are employees or contractors to Monash IVF and hold a minority stock position in Monash IVF. R.J.W. reports no conflict of interest.N/A.
AB -研究问题:母体在IVF/ICSI治疗中妊娠早期接触皮质类固醇是否会导致先天性异常的风险增加?结论:在IVF/ICSI辅助下出生的婴儿，其母亲在妊娠早期接受辅助皮质类固醇治疗，其患隐睾、尿道下裂和足底裂的风险增加。已知情况:母亲接触皮质类固醇可能会增加先天性异常的风险，如腭裂和神经管缺陷。然而，现有的研究结果相互矛盾，研究力度不足，并且没有研究接受体外受精/ICSI的人群，这一人群已知存在异常风险增加。研究设计、规模、持续时间:这项回顾性队列分析涵盖了澳大利亚墨尔本的莫纳什IVF生育诊所，评估了2010年至2016年间新鲜和冷冻胚胎移植的12426例活产婴儿的结果。参与者/材料、环境、方法:我们的研究组中有618例活产婴儿，这些母亲在IVF/ICSI治疗期间暴露于皮质类固醇(口服强的松龙或地塞米松)，其余婴儿未暴露于类固醇(对照组，n = 11,808)。测量的主要结果是先天性异常的存在，次要结果是出生体重和妊娠长度。采用多变量二元logistic回归来评估皮质类固醇暴露和胚胎冷冻的独立影响，并调整母亲取卵时的年龄、吸烟状况、服药周期数、BMI、不孕症的病因和ICSI的使用。结果以95% ci的发生率比(IRRs)表示。主要结果和偶然性的作用:在12 426例活产和597例出生缺陷中，多因素logistic回归显示马蹄内翻发生率增加(1.33% vs 0.32%，校正IRR = 4.30, 95% CI = 1.93, 9.58; P < 0.001), hypospadias (0.66% vs 0.18%, adjusted IRR = 5.90, 95% CI = 2.09, 16.69; P = 0.001) and cryptorchidism (0.83% vs 0.19%, adjusted IRR = 5.53, 95% CI = 1.91, 15.42; P = 0.001) in the offspring of mothers exposed to corticosteroids compared to those who were unexposed. The incidence of neither neural tube defects nor cleft palate were significantly increased in babies exposed to corticosteroids. The sex ratio of infants exposed to corticosteroids during a fresh embryo transfer cycle significantly favored males but reverted to the normal sex ratio in infants conceived in frozen embryo transfer cycles. LIMITATIONS, REASONS FOR CAUTION: This was a retrospective observational cohort study using administrative datasets with the potential for measurement error and unobserved confounding. Missing outcome data were obtained from patients using self-report leading to possible ascertainment bias. Given the rare incidence of some of the anomalies assessed, the study was underpowered to identify differences in abnormality rates for some specific anomalies. WIDER IMPLICATIONS OF THE FINDINGS: The findings of this study, the largest of its kind, suggest that caution should be heeded when prescribing corticosteroids to women undergoing IVF/ICSI, given that this study has now identified three previously unassociated serious neonatal complications (talipes, hypospadias and cryptorchidism), plus a potential alteration in sex ratio. Physicians should be careful in using corticosteroids in the critical first trimester and should counsel patients regarding the potential risks of this treatment. STUDY FUNDING/COMPETING INTEREST(S): There was no funding sought or obtained for this study. K.T., V.T., B.V. and D.Z.-F. are employees or contractors to Monash IVF and hold a minority stock position in Monash IVF. R.J.W. reports no conflict of interest.N/A.
KW -先天性异常
KW -皮质类固醇
Kw - icsi
Kw - ivf
强的松龙
KW -性别比
UR - http://www.scopus.com/inward/record.url?scp=85137137040&partnerID=8YFLogxK
U2 - 10.1093/humrep/deac142
10.1093/humrep/deac142
M3 -文章
C2 - 35734908
scopus:85137137040
Vl - 37
Sp - 2167
Ep - 2174
JO -人类生殖
JF -人类生殖
Sn - 0268-1161
是- 9
呃- - - - - -