Impact of corpus luteum number on maternal pregnancy and birth outcomes: the Rotterdam Periconception Cohort.

IF 6.6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY
Joni J Koerts, Lotte W Voskamp, Melek Rousian, Régine P M Steegers-Theunissen, Rosalieke E Wiegel
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引用次数: 0

Abstract

Objective: To investigate associations between assisted reproductive technology (ART)-induced alterations in corpus luteum (CL) number during implantation, and maternal pregnancy and birth outcomes. Pregnancies conceived through ART are associated with increased risks of adverse obstetric and perinatal outcomes, with discrepancies in outcomes between different ART treatment protocols. We hypothesize that this is because the periconceptional hormonal environment regulated by the CL. Assisted reproductive technology protocols affect CL quantity at conception resulting in CL absence or a supraphysiological number of CL.

Design: This study is embedded in the Rotterdam Periconceptional Cohort, an ongoing tertiary center prospective cohort at the Erasmus University Medical Center in Rotterdam, the Netherlands.

Subjects: Women with a singleton pregnancy with data on CL.

Intervention: The number of CL, based on mode of conception: 0 CL (artificial-cycle frozen embryo transfer, n = 72); >1 CL (ovarian stimulated fresh embryo transfer, n = 462), and 1 CL (natural-cycle frozen embryo transfer and natural conceptions, n = 1327).

Main outcome measures: Hypertensive disorders of pregnancy, gestational diabetes, gestational age at birth and birthweight, derived from medical records.

Results: We included 1,861 pregnancies. The results were adjusted for maternal age, maternal body mass index, nulliparity, and obstetric history. In comparison with natural conceptions (1 CL), a pregnancy with CL absence (0 CL) was associated with a higher risk of gestational diabetes (adjusted odds ratio [aOR]: 2.59 [95% confidence interval (CI): 1.31-5.15]), and a higher risk of preeclampsia, albeit non-significantly (aOR: 2.02 [95% CI: 0.91-4.51]). In comparison with pregnancies with >1 CL, the risk of preeclampsia was significantly lower (aOR: 0.36 [95% CI: 0.18-0.72]). Post hoc analyses revealed that in male neonates, >1 CL was associated with a lower birthweight percentile (aβ; -6.18 [95% CI: -11.16 to -1.20]). In contrast, female neonates showed no association with >1 CL, whereas CL absence was associated with a higher birthweight percentile (aβ: 12.93 [95% CI: 2.52-23.34]).

Conclusions: Risks of hypertensive disorders of pregnancy, gestational diabetes, and relative birthweight differ between CL groups. These findings support the hypothesis that an aberrant number of CL impacts maternal pregnancy and or birth outcomes. Additional studies need to be conducted to investigate causes and underlying pathophysiology.

Clinical trial registration number: NL4115 (https://onderzoekmetmensen.nl/en/trial/25560; date of registration: October 15, 2004; date of enrollment first subject: November 4, 2010).

黄体数量对孕妇妊娠和分娩结局的影响:鹿特丹围生期队列。
目的:探讨辅助生殖技术(ART)诱导的着床过程中黄体(CL)数目改变与孕产妇妊娠和分娩结局的关系。通过抗逆转录病毒治疗怀孕与不良产科和围产期结局的风险增加有关,不同的抗逆转录病毒治疗方案之间的结局存在差异。我们推测这是由于受CL调节的孕周激素环境所致。ART方案影响受孕时CL的数量,导致CL缺失或CL的超生理数量。设计:本研究纳入荷兰鹿特丹Erasmus大学医学中心正在进行的第三中心前瞻性队列——鹿特丹围概念队列。对象:有CL资料的单胎妊娠妇女。暴露:基于受孕方式的CL数:0 CL(人工周期冷冻胚胎移植(AC-FET), n=72);1 CL(卵巢刺激新鲜胚胎移植,n=462)和1 CL(自然周期冷冻胚胎移植(NC-FET)和自然受孕,n=1327)。主要结局指标:妊娠期高血压疾病、妊娠期糖尿病、出生胎龄和出生体重,来源于医疗记录。结果:我们纳入了1861例妊娠。结果调整了产妇年龄、产妇体重指数、无产和产科史。与自然受孕(1 CL)相比,CL缺失妊娠(0 CL)与妊娠期糖尿病的高风险相关(aOR 2.59 [95% CI 1.31;5.15]),与先兆子痫的高风险相关(aOR 2.02 [95% CI 0.91;4.51])。与bbb1 CL妊娠相比,先兆子痫的风险显著降低(aOR 0.36 [95% CI 0.18;0.72])。事后分析显示,在男性新生儿中,bbb1 CL与较低的出生体重百分位数相关(α β -6.18 [95% CI -11.16;-1.20])。相比之下,女性新生儿与bbb1 CL无关联,而CL缺失与较高的出生体重百分位数相关(α β 12.93 [95% CI 2.52;23.34])。结论:妊娠期高血压疾病、妊娠期糖尿病及相对出生体重在CL组间存在差异。这些发现支持了一个假设,即异常数量的CL会影响孕产妇妊娠和/或分娩结果。需要进行更多的研究来调查病因和潜在的病理生理学。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Fertility and sterility
Fertility and sterility 医学-妇产科学
CiteScore
11.30
自引率
6.00%
发文量
1446
审稿时长
31 days
期刊介绍: Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.
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