{"title":"辅助生殖技术与妊娠期糖尿病对早产的相互作用和联合作用以及妊娠期糖尿病的中介作用：一项使用倾向评分的队列研究","authors":"Yan-Xiao Xiang, Zhou Xu, Rui Xiao, Ying-Ling Yao, Xiao-Jun Tang, Li-Juan Fu, Li-Hong Geng, Zhao-Hui Zhong, Yu-Bin Ding","doi":"10.1007/s10815-024-03342-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether gestational diabetes mellitus (GDM) mediates the association between assisted reproductive technology (ART) and preterm birth (PTB), and to examine the interaction and joint effects of ART and GDM on PTB.</p><p><strong>Methods: </strong>This retrospective cohort study utilized data from 20,721 mothers with singleton live births at Sichuan Jinxin Xinan Women and Children's Hospital from January 2020 to December 2023. The exposures were ART and GDM, and the outcome was PTB. Multivariate logistic regression assessed the separate associations of ART and GDM with PTB. Mediation, interaction, and joint effects were analyzed using R software.</p><p><strong>Results: </strong>1,053 (5.08%) women experienced PTB. ART (OR 1.60; 95% CI 1.27-2.03) and GDM (OR 1.51; 95% CI 1.19-1.92) were both associated with increased PTB risk. GDM partially mediated the ART-PTB relationship (PM 2.72%; 95%CI 0.47%-8.86%). No additive interaction was found between GDM and ART for PTB in the general population. However, a significant additive interaction was observed in women aged ≥ 35 years (RERI 1.22; 95%CI 0.27-2.39). Compared to the spontaneous conception (SC)-non-GDM group, the SC-GDM (OR 1.56; 95%CI 1.07-2.29), ART-non-GDM (OR 1.63; 95%CI 1.22-2.18), and ART-GDM (OR 2.42; 95%CI 1.74-3.37) groups had higher PTB risk.</p><p><strong>Conclusions: </strong>ART was associated with higher PTB risk, partially mediated by GDM. Women undergoing ART who develop GDM may face greater PTB risk than those exposed to only one factor, with a synergistic effect in older pregnancies.</p>","PeriodicalId":15246,"journal":{"name":"Journal of Assisted Reproduction and Genetics","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Interacting and joint effects of assisted reproductive technology and gestational diabetes mellitus on preterm birth and the mediating role of gestational diabetes mellitus: a cohort study using a propensity score.\",\"authors\":\"Yan-Xiao Xiang, Zhou Xu, Rui Xiao, Ying-Ling Yao, Xiao-Jun Tang, Li-Juan Fu, Li-Hong Geng, Zhao-Hui Zhong, Yu-Bin Ding\",\"doi\":\"10.1007/s10815-024-03342-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To investigate whether gestational diabetes mellitus (GDM) mediates the association between assisted reproductive technology (ART) and preterm birth (PTB), and to examine the interaction and joint effects of ART and GDM on PTB.</p><p><strong>Methods: </strong>This retrospective cohort study utilized data from 20,721 mothers with singleton live births at Sichuan Jinxin Xinan Women and Children's Hospital from January 2020 to December 2023. The exposures were ART and GDM, and the outcome was PTB. Multivariate logistic regression assessed the separate associations of ART and GDM with PTB. Mediation, interaction, and joint effects were analyzed using R software.</p><p><strong>Results: </strong>1,053 (5.08%) women experienced PTB. ART (OR 1.60; 95% CI 1.27-2.03) and GDM (OR 1.51; 95% CI 1.19-1.92) were both associated with increased PTB risk. GDM partially mediated the ART-PTB relationship (PM 2.72%; 95%CI 0.47%-8.86%). No additive interaction was found between GDM and ART for PTB in the general population. However, a significant additive interaction was observed in women aged ≥ 35 years (RERI 1.22; 95%CI 0.27-2.39). Compared to the spontaneous conception (SC)-non-GDM group, the SC-GDM (OR 1.56; 95%CI 1.07-2.29), ART-non-GDM (OR 1.63; 95%CI 1.22-2.18), and ART-GDM (OR 2.42; 95%CI 1.74-3.37) groups had higher PTB risk.</p><p><strong>Conclusions: </strong>ART was associated with higher PTB risk, partially mediated by GDM. Women undergoing ART who develop GDM may face greater PTB risk than those exposed to only one factor, with a synergistic effect in older pregnancies.</p>\",\"PeriodicalId\":15246,\"journal\":{\"name\":\"Journal of Assisted Reproduction and Genetics\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-01-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Assisted Reproduction and Genetics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10815-024-03342-z\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GENETICS & HEREDITY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Assisted Reproduction and Genetics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10815-024-03342-z","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GENETICS & HEREDITY","Score":null,"Total":0}
引用次数: 0
摘要
目的：探讨妊娠期糖尿病（GDM）是否在辅助生殖技术（ART）与早产（PTB）之间起中介作用，并探讨ART与GDM对PTB的相互作用和联合作用。方法：本回顾性队列研究使用了2020年1月至2023年12月四川省金新市新安妇幼医院20,721名单胎活产母亲的数据。暴露是ART和GDM，结果是肺结核。多变量logistic回归评估ART和GDM与PTB的单独关联。采用R软件分析中介效应、交互效应和联合效应。结果：1053名（5.08%）女性经历了PTB。Art(或1.60；95% CI 1.27-2.03)和GDM (OR 1.51；95% CI 1.19-1.92)均与PTB风险增加相关。GDM部分介导ART-PTB关系(PM 2.72%；95%可信区间0.47% - -8.86%)。在一般人群中，未发现GDM和ART治疗肺结核的相互作用。然而，在年龄≥35岁的女性中观察到显著的加性相互作用(RERI 1.22；95%可信区间0.27 - -2.39)。与自然受孕(SC)-非gdm组相比，SC- gdm组(OR 1.56；95%CI 1.07-2.29)， art -非gdm (OR 1.63；95%CI 1.22-2.18), ART-GDM (OR 2.42；95%CI 1.74 ~ 3.37)组患PTB风险较高。结论：抗逆转录病毒治疗与更高的肺结核风险相关，部分由GDM介导。接受抗逆转录病毒治疗的发生GDM的妇女可能比只暴露于一种因素的妇女面临更大的PTB风险，在年龄较大的怀孕中具有协同效应。
Interacting and joint effects of assisted reproductive technology and gestational diabetes mellitus on preterm birth and the mediating role of gestational diabetes mellitus: a cohort study using a propensity score.
Objective: To investigate whether gestational diabetes mellitus (GDM) mediates the association between assisted reproductive technology (ART) and preterm birth (PTB), and to examine the interaction and joint effects of ART and GDM on PTB.
Methods: This retrospective cohort study utilized data from 20,721 mothers with singleton live births at Sichuan Jinxin Xinan Women and Children's Hospital from January 2020 to December 2023. The exposures were ART and GDM, and the outcome was PTB. Multivariate logistic regression assessed the separate associations of ART and GDM with PTB. Mediation, interaction, and joint effects were analyzed using R software.
Results: 1,053 (5.08%) women experienced PTB. ART (OR 1.60; 95% CI 1.27-2.03) and GDM (OR 1.51; 95% CI 1.19-1.92) were both associated with increased PTB risk. GDM partially mediated the ART-PTB relationship (PM 2.72%; 95%CI 0.47%-8.86%). No additive interaction was found between GDM and ART for PTB in the general population. However, a significant additive interaction was observed in women aged ≥ 35 years (RERI 1.22; 95%CI 0.27-2.39). Compared to the spontaneous conception (SC)-non-GDM group, the SC-GDM (OR 1.56; 95%CI 1.07-2.29), ART-non-GDM (OR 1.63; 95%CI 1.22-2.18), and ART-GDM (OR 2.42; 95%CI 1.74-3.37) groups had higher PTB risk.
Conclusions: ART was associated with higher PTB risk, partially mediated by GDM. Women undergoing ART who develop GDM may face greater PTB risk than those exposed to only one factor, with a synergistic effect in older pregnancies.
期刊介绍：
The Journal of Assisted Reproduction and Genetics publishes cellular, molecular, genetic, and epigenetic discoveries advancing our understanding of the biology and underlying mechanisms from gametogenesis to offspring health. Special emphasis is placed on the practice and evolution of assisted reproduction technologies (ARTs) with reference to the diagnosis and management of diseases affecting fertility. Our goal is to educate our readership in the translation of basic and clinical discoveries made from human or relevant animal models to the safe and efficacious practice of human ARTs. The scientific rigor and ethical standards embraced by the JARG editorial team ensures a broad international base of expertise guiding the marriage of contemporary clinical research paradigms with basic science discovery. JARG publishes original papers, minireviews, case reports, and opinion pieces often combined into special topic issues that will educate clinicians and scientists with interests in the mechanisms of human development that bear on the treatment of infertility and emerging innovations in human ARTs. The guiding principles of male and female reproductive health impacting pre- and post-conceptional viability and developmental potential are emphasized within the purview of human reproductive health in current and future generations of our species.
The journal is published in cooperation with the American Society for Reproductive Medicine, an organization of more than 8,000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology.
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