辅助生殖技术妊娠的孕龄确定模型比较
该研究基于挪威医学出生登记2015-2021年数据，比较辅助生殖技术（ART）妊娠的孕龄确定模型，评估14天或15天更准确反映ART妊娠卵泡期中位时长。研究发现超声模型与ART公式在孕龄和预产期上高度一致，但应采用15天而非14天以避免系统偏倚；鲜胚与冻胚移植妊娠的出生分布和妊娠中位时长不同，不应与自然妊娠等同评估。
要点
- ART妊娠孕龄计算应采用15天卵泡期中位时长，而非14天，以避免系统偏倚。
- 超声模型与ART公式在孕龄和预产期估计上精度相当，个体差异小。
- 鲜胚与冻胚移植妊娠的出生分布和妊娠时长不同，应与自然妊娠分开评估。
核心结论
- 超声与ART公式在孕龄和预产期上统计一致性良好，但ART公式应使用15天卵泡期时长。
- 鲜胚与冻胚移植妊娠的出生分布和妊娠中位时长不同，不应与自然妊娠等同评估，应分开评价。
研究设计与样本
- 比较基于人群的超声模型（GAUS）与基于已知卵母细胞受精日期的ART公式（GAART）在ART妊娠中的孕龄估计差异。
- 采用Kaplan-Meier累积出生分布曲线和时间-事件分析评估预产期的偏倚与精度。
主要发现
- 采用14天卵泡期中位时长时，超声与ART公式孕龄绝对差异≤1天的比例在鲜胚移植中为969/2067（46.9%），冻胚移植中为874/2080（42.0%）。
- 观察到约1天的系统差异，采用15天卵泡期时长（GAART,15）校正后，GAUS与GAART,15的中位配对差异在鲜胚移植中为-0.4天（95%CI，-0.5至-0.3），冻胚移植中为-0.2天（95%CI，-0.4至-0.1）。
- 两种模型在预产期估计上精度相当。
- 按超声模型测量，冻胚移植妊娠中位妊娠时长为286.1天（95%CI，285.5-286.7），比鲜胚移植长3.2天（95%CI，2.4-3.9），比自然妊娠长2.6天（95%CI，2.0-3.2）。
关键数值与推荐
- ART公式中卵泡期中位时长应采用15天，而非14天，以避免孕龄估计的系统偏倚。
临床怎么用
- 临床计算ART妊娠孕龄时，若使用基于受精日期的公式，应采用15天卵泡期时长。
- 鲜胚与冻胚移植妊娠的妊娠时长和出生分布不同，应分别评估，不应直接参照自然妊娠的标准。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
OBJECTIVES: To compare gestational age (GA) dating models for pregnancies conceived via assisted reproductive technology (ART), assess whether 14 or 15 days more accurately reflects the median follicular-phase duration in ART pregnancies and evaluate whether the gestational timelines of ART pregnancies are comparable with that of spontaneously conceived pregnancies. METHODS: We employed population data from the Medical Birth Registry of Norway (2015-2021), including 163 544 children conceived spontaneously, 2067 conceived via fresh embryo transfer (ET) and 2080 conceived via frozen ET. Among ART pregnancies, we compared two GA dating methods: a population-based ultrasound model (GAUS) and an ART-based formula based on the known oocyte fertilization date. Statistical agreement was evaluated by calculating individual pairwise differences in GA estimates. Bias and precision in the estimated date of delivery (EDD) were assessed by constructing cumulative birth distribution (Kaplan-Meier) curves for fresh and frozen ET pregnancies separately, employing time-to-event analysis to account for nonspontaneous births. RESULTS: The absolute individual GA differences between ultrasound and ART-based dating, considering a 14-day median follicular-phase duration, were ≤ 1 day for 969/2067 (46.9%) fresh ET pregnancies and for 874/2080 (42.0%) frozen ET pregnancies. An approximate systematic difference of 1 day was observed, which we corrected by employing a 15-day median follicular-phase duration in the ART-based formula (GAART,15). There was a median pairwise difference between GAUS and GAART,15 of -0.4 (95% CI, -0.5 to -0.3) days in fresh ET pregnancies and -0.2 (95% CI, -0.4 to -0.1) days in frozen ET pregnancies. Both models demonstrated equivalent precision in the EDD. Measured using the ultrasound model, frozen ET pregnancies had a median pregnancy duration of 286.1 (95% CI, 285.5-286.7) days, which was 3.2 (95% CI, 2.4-3.9) days longer than that in fresh ET pregnancies, and 2.6 (95% CI, 2.0-3.2) days longer than that in spontaneously conceived pregnancies. CONCLUSIONS: We found close statistical agreement between ultrasound and ART-based dating models for both GA and EDD. However, 15 (not 14) days of follicular-phase duration should be utilized in the ART-based formula to avoid systematic bias in ART-based GA estimates. Fresh and frozen ET pregnancies had different birth distributions and median pregnancy durations, underscoring that they are not comparable with spontaneously conceived pregnancies and they should be evaluated separately. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
引用
- Gjerdevik M, Hanevik HI, Håberg SE, et al. Gestational age determination in pregnancies conceived via assisted reproductive technology. Ultrasound Obstet Gynecol. 2026. PMID: 42060947. doi:10.1002/uog.70219
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。