辅助生殖技术助孕妊娠后患者晚期自然流产危险因素分析

doi:10.13481/j.1671-587X.20220525

Abstract

Abstract:

Objective To investigate the factors associated with late spontaneous abortion after pregnancy in the patients assisted by assisted reproductive technology （ART）， and to illuminate the risk factors for late spontaneous abortion. Methods Using retrospective research method， the clinical data of 310 pregnant patients underwent ART were collected； according to the different pregnancy outcomes of patients， they were divided into term birth group （248 cases） and late abortion group （62 cases）. The general situation， main causes and related factors of infertility， clinical situation and pregnancy outcomes of the patients in two groups were recorded， and the factors with P<0.05 in single factor regression analysis were included in the multivariate Logistic regression equation to further analyze the risk factors of late abortion. Results The differences in number of previous late miscarriages or preterm births， previous history of cervical LEEP or conization， previous history of hysteroscopic electrodesection， history of polycystic ovary syndrome（PCOS）， body mass index （BMI）， cycle type， endometrial thickness，whether twin pregnancies and ovulation disorder of the patients between two groups were statistically significant （P<0.05）.The factors with P<0.05 were included in the multivariate Logistic regression equation，BMI（OR=1.194，95%CI：1.088－1.311， P<0.01），previous history of late abortion or premature delivery（OR=5.673，95%CI：1.189－27.069， P=0.029）， history of cervical LEEP or conization（OR=5.113， 95%CI：1.025－25.496， P=0.047） and twin pregnancy（OR=5.129，95%CI：2.377－11.067，P<0.01） were the risk factors of late spontaneous abortion. Frozen thawed embryo transfer （FET） cycle was the protective factor of late abortion compared with fresh transplantation cycle （OR=0.422， 95% CI：0.219－0.814，P=0.010）. Conclusion Previous history of premature or late abortion， cervical surgery，high BMI and multiple pregnancy are the risk factors of late spontaneous abortion after ART-assisted pregnancy of the patients， while FET is the protective factor of late spontaneous abortion.

Key words: Late spontaneous abortion, Twin pregnancy, Cervical insufficiency, Body mass index, Assisted reproductive technology

CLC Number:

Hong GAO,Xiaohong YAN,Li LIN,Lulu REN,Youzhu LI. Analysis of risk factors of late spontaneous abortion after assisted reproductive technology-assisted pregnancy[J].Journal of Jilin University(Medicine Edition), 2022, 48(5): 1298-1304.

Figures/Tables 5

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

References 27

1	VAN DER BORGHT M， WYNS C. Fertility and infertility： definition and epidemiology［J］. Clin Biochem， 2018， 62： 2-10.
2	ZHENG F， XIN X， HE F， et al. Meta-analysis of the use of hyaluronic acid gel to prevent intrauterine adhesions after miscarriage［J］. Eur J Obstet Gynecol Reprod Biol， 2020， 244： 1-4.
3	陶丽梅，李晓凤，杨欣，等. 复发性流产患者社会心理相关因素的Logistics回归分析［J］. 中国计划生育和妇产科， 2020， 12（2）： 84-88.
4	王泽华，王艳丽. 妇产科学［M］. 8版. 北京：人民卫生出版社， 2019.
5	杨静薇，邓成艳，黄学锋，等. 中华医学会生殖医学分会2018年度辅助生殖技术数据报告［J］. 生殖医学杂志， 2021， 30（4）： 419-425.
6	陈士岭. 辅助生殖技术与自然流产［J］. 实用妇产科杂志， 2016， 32（2）： 87-89.
7	JIA C W， WANG L， LAN Y L， et al. Aneuploidy in early miscarriage and its related factors［J］. Chin Med J （Engl）， 2015， 128（20）： 2772-2776.
8	CHEN C D， CHIANG Y T， YANG P K， et al. Frequency of low serum LH is associated with increased early pregnancy loss in IVF/ICSI cycles［J］. Reprod Biomed Online， 2016， 33（4）： 449-457.
9	MCNAMEE K M， DAWOOD F， FARQUHARSON R G.Mid-trimester pregnancy loss［J］. Obstet Gynecol Clin North Am， 2014， 41（1）： 87-102.
10	LANGER B， GAUDINEAU A， SANANES N， et al. Management of patients with a history of late abortion or very premature delivery［J］. Gynecol Obstet Fertil， 2013， 41（2）： 123-129.
11	MCPHERSON E. Recurrence of stillbirth and second trimester pregnancy loss［J］. Am J Med Genet A， 2016， 170A（5）： 1174-1180.
12	秦帆，张琴，杨丽华. 宫颈机能不全的临床诊治进展［J］. 中国卫生标准管理， 2019， 10（6）： 30-33.
13	ALBRECHTSEN S， RASMUSSEN S， THORESEN S，et al. Pregnancy outcome in women before and after cervical conisation： population based cohort study［J］. BMJ， 2008， 337： a1343.
14	SZMULEWICZ C， NEVEU M E， VIGOUREUX S， et al. Emergency vaginal cervico-isthmic cerclage［J］. J Gynecol Obstet Hum Reprod， 2019， 48（6）： 391-394.
15	杨敬敬，杨春丽，职云晓，等. LEEP术后患者宫颈长度变化与妊娠及不良结局分析［J］. 中国计划生育学杂志， 2020， 28（9）： 1501-1503， 1508.
16	GÖKÇE A， SÜKÜR Y E， ÖZMEN B，et al. The association between operative hysteroscopy prior to assisted reproductive technology and cervical insufficiency in second trimester［J］. Arch Gynecol Obstet， 2021， 303（5）： 1347-1352.
17	STANKOVA T， GANOVSKA A， STOIANOVA M， et al. Complications of diagnostic and operative hysteroscopy： review［J］. Akush Ginekol （Sofiia）， 2015， 54（8）： 21-27.
18	刘寒艳，龙晓林，李磊，等. IVF/ICSI双胎妊娠新生儿结局及双胎妊娠影响因素分析［J］. 实用医学杂志， 2016， 32（18）： 3047-3050.
19	UYSAL N Ş， GÜLÜMSER Ç， BILGIN YANıK F F， et al. Outcome of ICSI pregnancies with spontaneous loss of a co-twin compared with singleton ICSI pregnancies： single center experience［J］. J Obstet Gynaecol Res， 2020， 46（3）： 445-450.
20	BORDI G， D’AMBROSIO A， GALLOTTA I， et al. The influence of ovulation induction and assisted conception on maternal and perinatal outcomes of twin pregnancies［J］. Eur Rev Med Pharmacol Sci， 2017，21（18）： 3998-4006.
21	杨学舟，章汉旺. 辅助生殖技术妊娠后异常时限分娩相关因素分析［J］. 现代妇产科进展， 2009， 18（12）： 925-928.
22	BU Z Q， HU L L， SU Y C， et al. Factors related to early spontaneous miscarriage during IVF/ICSI treatment： an analysis of 21， 485 clinical pregnancies［J］. Reprod Biomed Online， 2020， 40（2）： 201-206.
23	GHAZEERI G S， NASSAR A H， YOUNES Z， et al. Pregnancy outcomes and the effect of metformin treatment in women with polycystic ovary syndrome： an overview［J］. Acta Obstet Gynecol Scand， 2012，91（6）： 658-678.
24	CAI H， MOL B W， GORDTS S， et al. Early and late pregnancy loss in women with polycystic ovary syndrome undergoing IVF/ICSI treatment： a retrospective cohort analysis of 21 820 pregnancies［J］.BJOG， 2021，128（7）： 1160-1169.
25	张印峰，罗海宁，史蕊，等. 冻融胚胎移植周期中BMI对PCOS患者辅助生殖治疗结局的影响［J］. 中华妇产科杂志， 2021， 56（4）： 257-263.
26	HU L M， DU J B， LV H， et al. Influencing factors of pregnancy loss and survival probability of clinical pregnancies conceived through assisted reproductive technology［J］.Reprod Biol Endocrinol，2018，16（1）： 74.
27	YANG A M， XU X H， HAN Y， et al. Risk factors for different types of pregnancy losses： analysis of 15， 210 pregnancies after embryo transfer［J］. Front Endocrinol （Lausanne）， 2021， 12： 683236.

Group	n	Age(year)		Duration of infertility(year)	BMI (kg·m^－2)	FSH[λ_B/(IU·L^－1)]		LH [λ_B/(IU·L^－1)]
Group	n	Female	Male	Duration of infertility(year)	BMI (kg·m^－2)	FSH[λ_B/(IU·L^－1)]		LH [λ_B/(IU·L^－1)]
Term birth	248	30.96±4.06	32.34±4.61	3（2,5）	21.76±3.13	7.11±2.35		5.11±2.73
Late abortion	62	31.44±4.37	32.94±4.40	2 (1,4)	23.78±3.17	6.75±2.28		4.72±2.56
t/χ²/Z		－0.813	－0.852	1.817	－4.538	1.008		1.023
P		0.417	0.395	0.069	<0.01	0.278		0.307
Group	n	E2 [ρ_B/(μg·L^－1)]	Previous pregnancy[n(η/%)]	Previous artificial abortion [n(η/%)]	Previous preterm birth or late abortion [n(η/%)]		Previous term birth [n(η/%)]
Term birth	248	50.45±21.65	125(50.4)	50(20.2)	3(1.2)		57(23.0)
Late abortion	62	47.07±13.23	36(58.1)	17(27.4)	5(8.1)		18(29.0)
t/χ²/Z		1.560	1.166	1.542	6.744		0.989
P		0.271	0.280	0.214	0.009		0.320

Group	n	Tubal factor	Endometriosis	Ovulation disorder	Male factor	Bilateral factor	Ambiguous factor	LEEP or conization of cervix	Hysteroscopic electrotomy	PCOS
Term birth	248	86（34.7）	44（17.7）	15（6.0）	29（11.7）	47（19.0）	27（10.9）	4（1.6）	19（7.7）	37（14.9）
Late abortion	62	23（37.1）	8（12.9）	12（19.4）	3（4.8）	13（21.0）	3（4.8）	4（6.5）	10（16.1）	18（29.0）
χ²		0.127	0.832	11.045	1.832	0.129	1.442	4.619	4.194	6.769
P		0.721	0.362	0.001	0.176	0.719	0.230	0.032	0.041	0.009

Group	n	FET cycles	Endometrial thickness (l/mm)	Blastocyst transfered cycles	Two embryos transferred cycles	Twin pregnancy cycles
Term birth	248	123（49.6）	11.08±2.40	100（40.3）	142（57.3）	22（8.9）
Late abortion	62	42（67.7）	10.27±1.99	26（41.9）	43（69.4）	19（30.6）
t/χ²		6.560	2.738	0.053	3.016	20.491
P		0.010	0.007	0.817	0.082	<0.01

Variable	Assignment
Late spontaneous abortion	No=0；Yes=1
Previous preterm birth or late abortion	No=0；Yes=1
Ovulation disorder	No=0；Yes=1
PCOS	No=0；Yes=1
LEEP or conization of cervix	No=0；Yes=1
Hysteroscopic electrotomy	No=0；Yes=1
Cycle types	No=0；Yes=1
Twin pregnancy	No=0；Yes=1

Feature	Group	B value	Standard error of B value	OR 95%CI	Wald chisquare value	P value
BMI		0.177	0.048	1.194 1.088－1.311	13.908	<0.01
Previous preterm birth or late abortion	No^*
	Yes	1.736	0.797	5.673 1.189－27.069	4.739	0.029
Ovulation disorder	No^*
	Yes	－0.929	0.475	0.395 0.156－1.002	3.825	0.051
LEEP or conization of cervix	No^*
	Yes	1.632	0.820	5.113 1.025－25.496	5.113	0.047
Cycle types	Fresh cycle^*
	FET cycle	－0.862	0.335	0.422 0.219－0.814	6.620	0.010
Twin pregnancy	No^*
	Yes	1.635	0.392	5.129 2.377－11.067	17.355	<0.01

Analysis of risk factors of late spontaneous abortion after assisted reproductive technology-assisted pregnancy

RichHTML

PDF (PC)

Like

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 27

Related Articles 10

Metrics

Comments

Recommended 10

[1]	Jing YU,Yinzhuo HUANG,Zhongwei ZHOU,Yuxin XIE,Qian MAO. Analysis on influencing factors in type 2 diabetes mellitus patients complicated with lower limb atherosclerosis and construction of nomogram model [J]. Journal of Jilin University(Medicine Edition), 2026, 52(3): 806-812.
[2]	Yaping YE,Longmei WANG,Ping LI. AFC, AMH，sex hormone, and characteristics of glucose lipid metabolism in infertility patients with different phenotypes of polycystic ovatrian syndrome and their clinical significances [J]. Journal of Jilin University(Medicine Edition), 2025, 51(3): 757-762.
[3]	Weichao WU,Yan GUO,Xiangkai ZHAO,Zhiguang GU,Yijia GUO,Zipeng LAN,Hui HUANG,Lei KUANG,Ming ZHANG,Dongsheng HU,Yongli YANG,Wei WANG,Jinru CHEN. Correlation analysis on occupational acid fog exposure and accelerated biological aging in workers [J]. Journal of Jilin University(Medicine Edition), 2024, 50(6): 1741-1750.
[4]	Fang LIU,Jie ZHAO,Xiujuan CHEN,Saren WANG,Zeli TIAN,Shufang LI,Jing XI,Qin ZHANG. Effect of body mass index on pregnancy outcomes of patients with long regimen controlled ovarian hyperstimulation underwent fresh and freeze-thawed embryo transfer cycles [J]. Journal of Jilin University(Medicine Edition), 2023, 49(6): 1547-1553.
[5]	Yuanyuan YE,Xiaohong YAN,Youzhu LI. Analysis on related factors of pregnancy outcome after fresh embryo transfer in in-vitro fertilization/ intra-cytoplasmic sperm injection [J]. Journal of Jilin University(Medicine Edition), 2022, 48(2): 454-461.
[6]	LU Guoxiu, ZHANG Guoxu, HAO Shanhu, GUO Jia, ZHANG Wenwen, ZHANG Jinghua, WANG Zhiguo. PET/CT imaging and detection of levels of IL-6 and expression rates of ApoE in Alzheimer's disease patients with different body-mass indexes and their clinical significances [J]. Journal of Jilin University Medicine Edition, 2017, 43(03): 611-614.
[7]	FU Qianxi, ZHOU Li, TANG Min, ZHANG Mingjun, TANG Xiaojun. Analysis on association between polymorphism of apolipoprotein E genotypes and blood lipid levels in male population [J]. Journal of Jilin University Medicine Edition, 2015, 41(04): 808-813.
[8]	JIANG Lingling, YANG Xueling, LYU Wei, ZHANG Yue, YIN Yutian, WANG Yuhan, WANG Rui, ZHANG Peng, LI Bo, YAO Yan. Association between HLA-DRB1 gene polymorphisms and essential hypertension [J]. Journal of Jilin University Medicine Edition, 2015, 41(03): 619-624.
[9]	HAN Weiqing, WU Shili, LYU Wei, JIANG Lingling, YIN Yutian, ZHANG Yue, ZHANG Peng, WANG Rui, WANG Yuhan, LI Bo. Detection of levels of Mn,Fe,Zn,Ca,and Mg elements in hair of adults and their correlation with BMI [J]. Journal of Jilin University Medicine Edition, 2015, 41(02): 405-409.
[10]	ZHANG Li，LIANG Ming-hui，SU Ying-ying，YANG Xiao-lian，SONG Chang，LIU Ting，WU Ying. Survey and analysis on associations between dietary diversity  and overweight,obesity of rural adults in Jilin Province [J]. Journal of Jilin University Medicine Edition, 2014, 40(03): 682-685.