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首页> 外文期刊>BJOG: an international journal of obstetrics and gynaecology >Risk of severe maternal morbidity associated with in vitro fertilisation: a population-based study
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Risk of severe maternal morbidity associated with in vitro fertilisation: a population-based study

机译：与体外施肥有关的严重孕产妇发病的风险：基于人群的研究

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Objective To investigate the association between in vitro fertilisation IVF and severe maternal morbidity (SMM) and to explore the role of multiple pregnancy as an intermediate factor. Design Population-based cohort-nested case-control study. Setting Six French regions in 2012/13. Population Cases were 2540 women with SMM according to the EPIMOMS definition; controls were 3651 randomly selected women who gave birth without SMM. Methods Analysis of the associations between IVF and SMM with multivariable logistic regression models, differentiating IVF with autologous oocytes (IVF-AO) from IVF with oocyte donation (IVF-OD). The contribution of multiple pregnancy as an intermediate factor was assessed by path analysis. Main outcome measures Severe maternal morbidity overall and SMM according to its main underlying causal condition and by severity (near misses). Results The risk of SMM was significantly higher in women with IVF (adjusted OR = 2.5, 95% CI 1.8-3.3). The risk of SMM was significantly higher with IVF-AO, for all-cause SMM (aOR = 2.0, 95% CI 1.5-2.7), for near misses (aOR = 1.9, 95% CI 1.3-2.8), and for intra/postpartum haemorrhages (aOR = 2.3, 95% CI 1.6-3.2). The risk of SMM was significantly higher with IVF-OD, for all-cause SMM (aOR = 18.6, 95% CI 4.4-78.5), for near misses (aOR = 18.1, 95% CI 4.0-82.3), for SMM due to hypertensive disorders (aOR = 16.7, 95% CI 3.3-85.4) and due to intra/postpartum haemorrhages (aOR = 18.0, 95% CI 4.2-77.8). Path-analysis estimated that 21.6% (95% CI 10.1-33.0) of the risk associated with IVF-OD was mediated by multiple pregnancy, and 49.6% (95% CI 24.0-75.1) of the SMM risk associated with IVF-AO. Conclusion The risk of SMM is higher in IVF pregnancies after adjustment for confounders. Exploratory results suggest higher risks among women with IVF-OD; however, confidence intervals were wide, so this finding needs to be confirmed. A large part of the association between IVF-AO and SMM appears to be mediated by multiple pregnancy. Tweetable abstract The risk of severe maternal morbidity is higher in IVF-conceived pregnancies than in pregnancies conceived by other means.
机译：目的探讨体外受精IVF与严重孕产妇发病率（SMM）的关联，并探讨多重妊娠作为中间因素的作用。基于人口的群落嵌套案例控制研究。在2012/13中设置六个法国地区。根据剥离定义，人口案例为2540名SMM妇女;对照组是3651个随机选择的女性，在没有SMM的情况下出生。方法分析IVF和SMM与多变量逻辑回归模型的关联，将IVF与IVF与卵母细胞捐赠的IVF（IVF-OD）分化。通过路径分析评估多次妊娠作为中间因子的贡献。主要成果根据其主要潜在因果条件和严重程度（近乎未命中）来衡量严重的孕产妇发病率和SMM。结果IVF的女性中SMM的风险显着高（调整或= 2.5,95％CI 1.8-3.3）。 IVF-AO对SMM的风险显着高，对于所有原因SMM（AOR = 2.0,95％CI 1.5-2.7），近乎未命中（AOR = 1.9,95％CI 1.3-2.8），以及用于内/产后出血（AOR = 2.3,95％CI 1.6-3.2）。 IVF-OD的SMM风险显着高，对于所有原因SMM（AOR = 18.6,95％CI 4.4-78.5），近乎未命中（AOR = 18.1,95％CI 4.0-82.3），因为SMM高血压障碍（AOR = 16.7,95％CI 3.3-85.4），并且由于内外出血（AOR = 18.0,95％CI 4.2-77.8）。路径分析估计，与IVF-OD相关的21.6％（95％CI10.1-33.0）由多次妊娠介导，49.6％（95％CI 24.0-75.1）与IVF-AO相关的SMM风险。结论对混凝剂调整后IVF妊娠的风险较高。探索性结果表明患有IVF-OD的女性的风险更高;但是，置信区间宽，所以需要确认这种发现。 IVF-AO和SMM之间的大部分关联似乎是多次怀孕的介导。 Twelable摘要IVF构思怀孕的严重孕产妇发病率的风险高于其他手段的怀孕。

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