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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2023, Vol. 19 ›› Issue (01): 46 -53. doi: 10.3877/cma.j.issn.1673-5250.2023.01.007

Original Article

Birth trends and adverse pregnancy outcomes of live births under assisted reproductive technology in Beijing, 2015-2021

Lu Zhang, Huijuan Yang, Kaibo Liu†()   

  1. Beijing Obstetrics and Gynecology Hospital, Capital Medical University/Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
  • Received:2022-05-08 Revised:2022-12-30 Published:2023-02-01
  • Corresponding author: Kaibo Liu
  • Supported by:
    Special Project of Capital Health Development and Research(2018-2-2111)
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Objective

To explore the changing trend of assisted reproductive technology (ART) conceptions and adverse pregnancy outcomes among the live birth population in Beijing from 2015-2021.

Methods

The monitoring data of Beijing Maternal and Child Health Network Information System (BMCHINS) from 2015 to 2021 were extracted, and the trends of adverse pregnancy outcomes such as premature birth, low birth weight, full-term small baby and other risk factors of adverse outcomes of live births (hereinafter referred to as ART mothers) conceived by ART during these seven years were analyzed retrospectively. The study was conducted in accordance with World Medical Association Declaration of Helsinki revised in 2013.

Results

① From 2015 to 2021, a total of 43 485 ART live births and 36 056 ART mothers were monitored by BMCHINS. During these seven years, the proportion of ART live-born children and their mothers increased, and the differences were statistically significant (χ2=9 292.59, 8 750.12; P<0.001). ② The proportions of ART older pregnant women aged ≥35 years and ≥40 years were 36.3% (13 085/36 056) and 6.5% (2 340/36 056), respectively, which were significantly higher than those among all mothers [16.1% (224 295/1 389 457) and 2.0% (27 983/1 389 457)], with statistically significant differences (χ2=10 279.08, 3 381.89; P<0.001). The difference was statistically significant when comparing the increasing trend of ART conception rate among older mothers aged ≥35 years and ≥40 years (χ2=1 954.96, 317.91; P<0.001). ③ The rate of multiple births among ART live births was 34.3% (14 913/43 485), which was significantly higher than 3.1% of all live births (44 106/1 411 926), and the difference was statistically significant (χ2=105 349.58, P<0.001). The increasing trend in the rate of ART births among multiple live births over 7 years was compared with a statistically significant (χ2=1 542.36, P<0.001). ④ The preterm birth rates among ART live births at gestational age<37 weeks and <32 weeks were 20.6% (8 967/43 485) and 2.7% (1 153/43 485), respectively, which were significantly higher than those of all live births at 6.1% (85 481/1 411 926) and 0.6% (8 274/1 411 926), and both differences were statistically significant (χ2=14 750.94, 2 796.68, P<0.001). The difference was statistically significant when comparing the upward trend in the rate of ART births among preterm live births over 7 years, respectively (χ2=926.96, 74.16, P<0.001). ⑤The difference was statistically significant when comparing the increasing trend of conception rate via ART among those with birth weight <2 500 g and <1 500 g over 7 years (χ2=804.68, 66.79, P<0.001).

Conclusions

The contribution of ART to the live birth population in Beijing is increasing year by year, and the risk of preterm birth and low birth weight among ART live births is increasing. Reducing the rate of ART multiple births is an effective measure to reduce the incidence of preterm birth and low birth weight.

Key words: Reproductive techniques, assisted, Infant, premature, Infant, low birth weight, Maternal age, Pregnancy, multiple, Infant, small for gestational age, Pregnant women
表1 2015—2021年北京市ART助孕活产率及助孕分娩活产儿孕母占比比较[%(n/n′)]
年份(年) ART活产儿 ART孕母占比
2015 1.4(2 661/191 805) 1.1(2 090/188 840)
2016 1.9(4 488/232 217) 1.6(3 562/228 630)
2017 2.1(5 390/259 233) 1.7(4 326/255 221)
2018 3.1(6 499/208 995) 2.6(5 286/205 579)
2019 3.8(8 044/213 886) 3.2(6 731/210 457)
2020 3.8(7 759/160 303) 4.2(6 610/157 739)
2021 5.9(8 644/145 487) 5.2(7 451/142 991)
总体占比 3.1(43 485/1 411 926) 2.6(36 056/1 389 457)
表2 2015—2021年北京市ART高龄、超高龄孕妇占比情况及总体占比情况比较
年份(年) ART孕母[%(n1/n1′)] 全部孕母[%(n2/n2′)] ART孕母/全部孕母[%(n1/n2)]
高龄 超高龄 高龄 超高龄 高龄 超高龄
2015 32.1(670/2 090) 5.6(117/2 090) 11.4(21 489/188 840) 1.3(2 542/188 840) 3.1(670/21 489) 4.6(117/2 542)
2016 31.7(1 129/3 562) 5.3(188/3 562) 11.7(26 688/228 630) 1.3(3 085/228 630) 4.2(1 129/26 688) 6.1(188/3 085)
2017 34.1(1 474/4 326) 5.8(253/4 326) 16.8(42 991/255 221) 2.0(5 076/255 221) 3.4(1 474/42 991) 5.0(253/5 076)
2018 39.1(2 069/5 286) 6.6(348/5 286) 19.2(39 392/205 579) 2.5(5 112/205 579) 5.3(2 069/39 392) 6.8(348/5 112)
2019 37.9(2 552/6 731) 7.6(510/6 731) 17.3(36 433/210 457) 2.2(4 606/210 457) 7.0(2 552/36 433) 11.1(510/4 606)
2020 36.6(2 419/6 610) 6.5(430/6 610) 19.0(29 950/157 739) 2.5(3 974/157 739) 8.1(2 419/29 950) 10.8(430/3 974)
2021 37.2(2 772/7 451) 6.6(494/7 451) 19.1(27 352/142 991) 2.5(3 588/142 991) 10.1(2 772/27 352) 13.8(494/3 588)
总体占比 36.3 (13 085/36 056) 6.5 (2 340/36 056) 16.1 (224 295/1 389 457) 2.0 (27 983/1 389 457) 5.8(13 085/224 295) 8.4(2 340/27 983)
表3 2015—2021年北京市ART活产儿与全部活产儿中多胎妊娠占比变化趋势
年份(年) ART多胎活产儿/ART活产儿[%(n1/n1′)] 全部多胎活产儿/全部活产儿[%(n2/n2′)] ART多胎活产儿/全部多胎活产儿[%(n1/n2)]
2015 42.8(1 140/2 661) 3.1(5 902/191 805) 19.3(1 140/5 902)
2016 42.8(1 920/4 488) 3.0(7 029/232 217) 27.3(1 920/7 029)
2017 39.2(2 113/5 390) 2.9(7 444/259 233) 28.4(2 113/7 444)
2018 37.6(2 441/6 499) 3.3(6 804/208 995) 35.9(2 441/6 804)
2019 32.5(2 617/8 044) 3.2(6 831/213 886) 38.3(2 617/6 831)
2020 29.7(2 303/7 759) 3.2(5 115/160 303) 45.0(2 303/5 115)
2021 27.5(2 379/8 644) 3.4(4 981/145 487) 47.8(2 379/4 981)
总体发生率 34.3(14 913/43 485) 3.1(44 106/1 411 926) 33.8(14 913/44 106)
表4 2015—2021年北京市ART活产儿与全部活产儿中早产儿(出生胎龄分别为胎龄<37周和<32周)占比变化趋势
年份(年) ART活产儿的早产率[%(n1/n1′)] 全部活产儿的早产率[%(n2/n2′)] 早产儿中经ART占比[%(n1/n2)]
胎龄<37周 胎龄<32周 胎龄<37周 胎龄<32周 胎龄<37周 胎龄<32周
2015 20.7(550/2 661) 1.7(45/2 661) 5.0(9 666/191 805) 0.4(766/191 805) 5.7(550/9 666) 5.9(45/766)
2016 23.3(1 047/4 488) 3.2(144/4 488) 5.8(13 467/232 217) 0.6(1 320/232 217) 7.8(1 047/13 467) 10.9(144/1 320)
2017 21.4(1 154/5 390) 3.4(183/5 390) 5.7(14 901/259 233) 0.5(1 425/259 233) 7.7(1 154/14 901) 12.8(183/1 425)
2018 23.1(1 502/6 499) 2.9(187/6 499) 6.2(12 987/208 995) 0.6(1 269/208 995) 11.6(1 502/12 987) 14.7(187/1 269)
2019 19.8(1 595/8 044) 2.6(209/8 044) 6.3(13 536/213 886) 0.6(1 300/213 886) 11.8(1 595/13 536) 16.1(209/1 300)
2020 19.0(1 474/7 759) 2.4(183/7 759) 6.7(10 795/160 303) 0.7(1 058/160 303) 13.7(1 474/10 795) 17.3(183/1 058)
2021 19.0(1 645/8 644) 2.3(202/8 644) 7.0(10 129/145 487) 0.8(1 136/145 487) 16.2(1 645/10 129) 17.8(202/1 136)
总体占比 20.6(8 967/43 485) 2.7(1 153/43 485) 6.1(85 481/1 411 926) 0.6(8 274/1 411 926) 10.5(8 967/85 481) 13.9(1 153/8 274)
表5 2015—2021年北京市ART活产儿中低出生体重儿(出生体重<2 500g和出生体重<1 500 g)占比变化趋势
年份(年) ART活产儿中低出生体重发生率[%(n1/n1′)] 全部活产儿中低出生体重发生率[%(n2/n2′)] 低出生体重儿中经ART占比[%(n1/n2)]
出生体重<2 500 g 出生体重<1 500 g 出生体重<2 500 g 出生体重<1 500 g 出生体重<2 500 g 出生体重<1 500 g
2015 19.1(508/2 661) 1.4(36/2 661) 3.8(7233/191 805) 0.3(592/191 805) 7.0(508/7 233) 6.1(36/592)
2016 20.1(902/4 488) 2.6(118/4 488) 4.2(9780/232 217) 0.5(1 207/232 217) 9.2(902/9 780) 9.8(118/1 207)
2017 19.6(1 058/5 390) 2.6(141/5 390) 4.1(10 629/259 233) 0.5(1 183/259 233) 10.0(1 058/10 629) 11.9(141/1 183)
2018 19.9(1 294/6 499) 2.4(157/6 499) 4.5(9 495/208 995) 0.5(1 037/208 995) 13.6(1 294/9 495) 15.1(157/1 037)
2019 17.9(1 442/8 044) 1.9(156/8 044) 4.7(10 074/213 886) 0.5(1 029/213 886) 14.3(1 442/10 074) 15.2(156/1 029)
2020 16.8(1 305/7 759) 1.9(149/7 759) 4.9(7 895/160 303) 0.5(818/160 303) 16.5(1 305/7 895) 18.2(149/818)
2021 17.3(1 496/8 644) 1.7(146/8 644) 5.3(7 773/145 487) 0.6(856/145 487) 19.2(1 496/7 773) 17.1(146/856)
总体发生率 18.4(8 005/43 485) 2.1(903/43 485) 4.5(62 879/1 411 926) 0.5(6 722/1 411 926) 12.7(8 005/62 879) 13.4(903/6 722)
表6 2015—2021年北京市ART单胎活产儿早产(胎龄<37周)、低出生体重(出生体重<2 500 g)和足月小样儿占比变化趋势
年份(年) ART单胎活产儿中占比[%(n1/n1′)] 全部单胎活产儿中占比[%(n2/n2′)]
早产儿 低出生体重儿 足月小样儿 早产儿 低出生体重儿
2015 7.4 (113/1 521) 4.7 (71/1 521) 1.2 (19/1 521) 3.8 (7 141/185 903) 2.6 (4 752/185 903)
2016 8.5 (219/2 568) 5.5 (141/2 568) 1.1 (27/2 568) 4.6 (10 362/225 188) 3.0 (6 840/225 188)
2017 7.3 (240/3 277) 5.0 (165/3 277) 0.9 (28/3 277) 4.6 (11 512/251 789) 2.9 (7 415/251 789)
2018 8.2 (332/4 058) 5.4 (218/4 058) 0.9 (36/4 058) 4.8 (9 713/202 191) 3.2 (6 372/202 191)
2019 8.0 (435/5 427) 5.7 (307/5 427) 1.1 (60/5 427) 5.0 (10 269/207 055) 3.3 (6 872/207 055)
2020 7.9 (433/5 456) 5.2 (282/5 456) 0.9 (50/5 456) 5.4 (8 353/155 188) 3.6 (5 539/155 188)
2021 8.1 (510/6 265) 6.0 (375/6 265) 1.3 (83/6 265) 5.4 (7 619/140 506) 3.8 (5 324/140 506)
总体占比 8.0 (2 282/28 572) 5.5 (1 559/28 572) 1.1 (303/28 572) 4.7 (64 969/1 367 820) 3.2 (43 114/1 367 820)
年份(年) 全部单胎活产儿中占比[%(n2/n2′)] 全部单胎活产儿中经ART助孕者[%(n1/n2)]
足月小样儿 早产儿 低出生体重儿 足月小样儿
2015 0.9 (1 627/185 903) 1.6(113/7 141) 1.5(71/4 752) 1.2(19/1 627)
2016 0.9 (2 054/225 188) 2.1(219/10 362) 2.1(141/6 840) 1.3(27/2 054)
2017 0.9 (2 352/251 789) 2.1(240/11 512) 2.2(165/7 415) 1.2(28/2 352)
2018 0.9 (1 877/202 191) 3.4(332/9 713) 3.4(218/6 372) 1.9(36/1 877)
2019 1.0 (2 078/207 055) 4.2(435/10 269) 4.5(307/6 872) 2.9(60/2 078)
2020 1.0 (1 617/155 188) 5.2(433/8 353) 5.1(282/5 539) 3.1(50/1 617)
2021 1.1 (1 582/140 506) 6.7(510/7 619) 7.0(375/5 324) 5.2(83/1 582)
总体占比 1.0 (13 187/1 367 820) 3.5(2 282/64 969) 3.6(1 559/43 114) 2.3(303/13 187)
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