BACKGROUND Preimplantation genetic testing (PGT) includes methods that allow embryos to be tested for severe inherited diseases or chromosomal abnormalities. In addition to IVF/ICSI and repeated freezing and thawing of the embryos, PGT requires a biopsy to obtain embryonic genetic material for analysis. However, the potential effects of PGT on obstetric and neonatal outcomes are currently uncertain. OBJECTIVE AND RATIONALE This study aimed to investigate whether pregnancies conceived after PGT were associated with a higher risk of adverse obstetric and neonatal outcomes compared with spontaneously conceived (SC) pregnancies or pregnancies conceived after IVF/ICSI. SEARCH METHODS PubMed, EMBASE, MEDLINE, Web of Science and The Cochrane Library entries from January 1990 to January 2021 were searched. The primary outcomes in this study were low birth weight (LBW) and congenital malformations (CMs), and the secondary outcomes included gestational age, preterm delivery (PTD), very preterm delivery (VPTD), birth weight (BW), very low birth weight (VLBW), neonatal intensive care unit (NICU) admission, hypertensive disorders of pregnancy (HDP), gestational diabetes, placenta previa and preterm premature rupture of membranes (PROM). We further pooled the results of PGT singleton pregnancies. Subgroup analyses included preimplantation genetic diagnosis (PGD), preimplantation genetic screening (PGS), cleavage-stage biopsy combined with fresh embryo transfer (CB-ET) and blastocyst biopsy combined with frozen-thawed embryo transfer (BB-FET). OUTCOMES This meta-analysis included 15 studies involving 3682 babies born from PGT pregnancies, 127 719 babies born from IVF/ICSI pregnancies and 915 222 babies born from SC pregnancies. The relative risk (RR) of LBW was higher in PGT pregnancies compared with SC pregnancies (RR = 3.95, 95% confidence interval [CI]: 2.32–6.72), but the risk of CMs was not different between the two groups. The pooled results for the risks of LBW and CMs were similar in PGT and IVF/ICSI pregnancies. The risks of PTD (RR = 3.12, 95% CI: 2.67–3.64) and HDP (RR = 3.12, 95% CI: 2.18–4.47) were significantly higher in PGT pregnancies compared with SC pregnancies. Lower gestational age (mean difference [MD] = −0.76 weeks, 95% CI −1.17 to −0.34) and BW (MD = −163.80 g, 95% CI: −299.35 to −28.24) were also noted for PGT pregnancies compared with SC pregnancies. Nevertheless, compared with IVF/ICSI pregnancies, the risks of VPTD and VLBW in PGT pregnancies were significantly decreased by 41% and 30%, respectively, although the risk of HDP was still significantly increased by 50% in PGT pregnancies compared with IVF/ICSI pregnancies. The combined results of obstetric and neonatal outcomes of PGT and IVF/ICSI singleton pregnancies were consistent with the overall results. Further subgroup analyses indicated that both PGD and PGS pregnancies were associated with a higher risk of PTD and a lower gestational age compared with SC pregnancies. WIDER IMPLICATIONS This meta-analysis showed that PGT pregnancies may be associated with increased risks of LBW, PTD and HDP compared with SC pregnancies. The overall obstetric and neonatal outcomes of PGT pregnancies are favourable compared with those of IVF/ICSI pregnancies, although PGT pregnancies were associated with a higher risk of HDP. However, because the number of studies that could be included was limited, more randomised controlled trials and prospective cohort studies are needed to confirm these conclusions.

中文翻译：

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植入前基因检测导致妊娠的产科和新生儿结局：系统评价和荟萃分析

背景技术植入前基因检测(PGT)包括允许对胚胎进行严重遗传疾病或染色体异常检测的方法。除了 IVF/ICSI 和反复冻融胚胎外，PGT 还需要进行活检以获得胚胎遗传物质进行分析。然而，PGT 对产科和新生儿结局的潜在影响目前尚不确定。目的和理由 本研究旨在调查与自然受孕 (SC) 妊娠或 IVF/ICSI 后受孕的妊娠相比，PGT 后妊娠是否与更高的产科和新生儿不良结局风险相关。检索方法 检索了 PubMed、EMBASE、MEDLINE、Web of Science 和 Cochrane 图书馆 1990 年 1 月至 2021 年 1 月的条目。本研究的主要结局是低出生体重（LBW）和先天畸形（CMs），次要结局包括胎龄、早产（PTD）、极早产（VPTD）、出生体重（BW）、极低出生体重（VLBW）、新生儿重症监护病房（NICU）入院、妊娠期高血压疾病（HDP）、妊娠糖尿病、前置胎盘和早产胎膜早破（PROM）。我们进一步汇总了 PGT 单胎妊娠的结果。亚组分析包括胚胎植入前遗传学诊断（PGD）、胚胎植入前遗传学筛查（PGS）、卵裂期活检联合新鲜胚胎移植（CB-ET）和囊胚活检联合冻融胚胎移植（BB-FET）。结果 这项荟萃分析包括 15 项研究，涉及 3682 名 PGT 妊娠所生婴儿，127 719 名 IVF/ICSI 怀孕婴儿和 915 222 名 SC 怀孕婴儿。与 SC 妊娠相比，PGT 妊娠的 LBW 相对风险 (RR) 更高（RR = 3.95, 95% 置信区间 [CI]: 2.32-6.72），但两组之间发生 CM 的风险没有差异。LBW 和 CM 风险的汇总结果在 PGT 和 IVF/ICSI 妊娠中相似。与 SC 妊娠相比，PGT 妊娠的 PTD (RR = 3.12, 95% CI: 2.67–3.64) 和 HDP (RR = 3.12, 95% CI: 2.18–4.47) 的风险显着更高。与 PGT 妊娠相比，PGT 妊娠的胎龄较低（平均差异 [MD] = -0.76 周，95% CI -1.17 至 -0.34）和 BW（MD = -163.80 g，95% CI：-299.35 至 -28.24）也被注意到SC怀孕。然而，与 IVF/ICSI 妊娠相比，PGT 妊娠中 VPTD 和 VLBW 的风险分别显着降低了 41% 和 30%，尽管与 IVF/ICSI 妊娠相比，PGT 妊娠中 HDP 的风险仍然显着增加了 50%。PGT和IVF/ICSI单胎妊娠的产科和新生儿结局的综合结果与总体结果一致。进一步的亚组分析表明，与 SC 妊娠相比，PGD 和 PGS 妊娠均与更高的 PTD 风险和更低的胎龄相关。更广泛的影响 这项荟萃分析表明，与 SC 妊娠相比，PGT 妊娠可能与 LBW、PTD 和 HDP 风险增加有关。与 IVF/ICSI 妊娠相比，PGT 妊娠的总体产科和新生儿结局是有利的，尽管 PGT 妊娠与 HDP 的较高风险相关。然而，由于可以纳入的研究数量有限，需要更多的随机对照试验和前瞻性队列研究来证实这些结论。