辅助生殖技术与子代先天性心脏缺陷风险：系统综述与荟萃分析。
完整摘要 · 中文译文
背景：迄今为止，全球已有超过1000万儿童通过辅助生殖技术（ART）受孕。然而，人们对ART受孕妊娠相关的潜在不良结局存在一些担忧，包括先天性心脏缺陷（CHDs）的风险。本荟萃分析旨在评估ART与重大CHDs及其特定亚型风险之间的关联。 方法：筛选主要电子数据库，纳入比较ART受孕妊娠后CHD发生率与自然受孕后CHD发生率的研究。主要终点为研究定义的CHDs发生率。次要终点包括法洛四联症、大动脉转位、主动脉缩窄、室间隔缺损、房间隔缺损、肺动脉瓣闭锁、三尖瓣闭锁和左心发育不良的发生率。采用频率学派随机效应模型进行配对荟萃分析，计算风险比和95%CI。 结果：共纳入13项研究，合计45 916 925名受试者（其中4986名通过ART受孕），进入定量合成分析。与自然妊娠相比，ART与重大CHD风险显著升高相关（风险比，2.35 [95%CI，1.68-3.28]），且各研究间存在显著异质性。ART受孕妊娠后法洛四联症、室间隔缺损和房间隔缺损的风险增加，而其他CHDs未见差异。预设的敏感性分析与荟萃分析的主要发现一致。 结论：我们的荟萃分析显示，辅助生殖技术（ART）与重大先天性心脏病（CHD）风险增加之间存在潜在关联，尤其是法洛四联症、室间隔缺损和房间隔缺损。
完整摘要 · 英文原文
BACKGROUND: To date, >10 million children have been conceived via assisted reproductive technology (ART) globally. However, there are some concerns about potential adverse outcomes associated with ART-conceived pregnancies, including the risk of congenital heart defects (CHDs). This meta-analysis aimed to evaluate the association between ART and the risk of major CHDs as well as their specific subtypes. METHODS: Major electronic databases were screened for studies comparing the incidence of CHD following ART-conceived pregnancies versus spontaneous conception. The primary end point was study-defined incidence of CHDs. Secondary end points included incidence of tetralogy of Fallot, transposition of the great arteries, aortic coarctation, ventricular septal defect, atrial septal defect, pulmonary valve atresia, tricuspid valve atresia, and hypoplastic left heart. Pairwise meta-analyses were performed using frequentist random-effect models to calculate risk ratios and 95% CIs. RESULTS: Thirteen studies, encompassing a total of 45 916 925 subjects (4986 conceived via ART), were included in the quantitative synthesis. ART was significantly associated with a higher risk of major CHD compared with natural pregnancy (risk ratio, 2.35 [95% CI, 1.68-3.28]), with significant heterogeneity across the studies. An increased risk of tetralogy of Fallot, ventricular septal defect, and atrial septal defect following ART-conceived pregnancies was found, while no difference was found on other CHDs. Prespecified sensitivity analyses were in line with the primary findings of the meta-analysis. CONCLUSIONS: Our meta-analysis shows a potential link between ART and increased risk of major CHDs, particularly on tetralogy of Fallot, ventricular septal defect, and atrial septal defect.