Comparative study of clinical outcome in singleton pregnant women with gestational diabetes mellitus combined with in vitro fertilisation-embryo transfer
Objective To analyse the clinical outcomes of singleton pregnant women with gestational diabetes mellitus(GDM)combined with in vitro fertilization-embryo transfer(IVF-ET),in order to clarify whether the frozen embryo transfer(FET)technique increases the risk of adverse pregnancy outcomes during gestation and delivery in the GDM population.Methods With retrospective analysis,114 pregnant women who underwent FET and had a single full-term live birth with GDM diagnosed during pregnancy at the Reproductive Centre of the Second Affiliated Hospital of Air Force Medical University between November 2020 and May 2022 were selected as the frozen embryo group,75 pregnant women who underwent fresh embryo transfer and had a single full-term live birth with GDM diagnosed during pregnancy as the fresh embryo group,and 229 pregnant women who underwent natural pregnancy combined with GDM as the natural pregnancy group during the same period were selected.Maternal general conditions,complications during labour,and adverse neonatal outcomes were compared between the frozen embryo group and the natural pregnancy group,and between the fresh embryo group and the natural pregnancy group,respectively.Statistical analysis was conducted.Results The differences between the frozen embryo group and the natural pregnancy group were statistically significant when comparing pregnant women's postprandial blood glucose at 1 hour(t=2.817),postprandial blood glucose at 2 hours(Z=3.804),pre-pregnancy body mass index(BMI)(Z=2.745),the proportion of cesarean section history(x2=11.642),the proportion of primiparous women(x2=20.218),and the cesarean section rate(x2=17.863)(all P＜0.05).The occurrence of abnormal amniotic fluid in the frozen embryo group was 2.507 times higher than that in the natural pregnancy group(P=0.017).Multivariate logistic regression analysis showed that the frozen embryo group had a 0.215 times lower risk of postpartum hemorrhage compared to the natural pregnancy group(P=0.015,adjusted OR=0.215),and a 4.098 times higher risk of abnormal amniotic fluid(P=0.019,adjusted OR=4.098).There were statistically significant differences in fetal abdominal circumference,neonatal birth weight,and birth length between the frozen embryo group and natural pregnancy group(Z=2.285,3.736,4.935,respectively,P＜0.05).The occurrence of macrosomia in the frozen embryo group was 2.496 times higher than that in the natural pregnancy group(P=0.007).The frozen embryo group had a 4.106 times higher risk of macrosomia compared to the natural pregnancy group(P=0.010,adjusted OR=4.106).For the fresh embryo group compared to the natural pregnancy group,there were statistically significant differences in fasting blood glucose(FPG)(Z=2.299),postprandial blood glucose at 1 hour(t=2.605),postprandial blood glucose at 2 hours(Z=2.491),pre-pregnancy BMI(Z=4.683),the proportion of live births ≥1(x2=7.390),and the proportion of primiparous women(x2=19.534)(all P＜0.05).The incidence of postpartum hemorrhage in the fresh embryo group was 3.761 times higher than that in the natural pregnancy group(P=0.006),and the incidence of premature rupture of membranes in the fresh embryo group was 0.303 times lower than that in the natural pregnancy group(P=0.009).The fresh embryo group had a 3.756 times higher risk of postpartum hemorrhage compared to the natural pregnancy group(P=0.029,adjusted OR=3.756).The incidence of low birth weight(LBW)in the fresh embryo group was 11.794 times higher than that in the natural pregnancy group(P＜0.001).There was no statistically significant difference in the incidence of macrosomia,LBW,and neonatal asphyxia between the fresh embryo group and natural pregnancy group(all P＞0.05).Conclusion Compared with natural pregnancy with GDM,FET increases the incidence of abnormal amniotic fluid and macrosomia and decreases the incidence of postpartum hemorrhage.Fresh embryo transfer increases the incidence of postpartum hemorrhage.
万方数据
维普
