The use of assisted reproductive technology has increased in the United States in the past several decades. Although most of these pregnancies are uncomplicated, in vitro fertilization is associated with an increased risk for adverse perinatal outcomes primarily caused by the increased risks of prematurity and low birthweight associated with in vitro fertilization pregnancies. This Consult discusses the management of pregnancies achieved with in vitro fertilization and provides recommendations based on the available evidence. The recommendations by the Society for Maternal-Fetal Medicine are as follows: (1) we suggest that genetic counseling be offered to all patients undergoing or who have undergone in vitro fertilization with or without intracytoplasmic sperm injection (GRADE 2C); (2) regardless of whether preimplantation genetic testing has been performed, we recommend that all patients who have achieved pregnancy with in vitro fertilization be offered the options of prenatal genetic screening and diagnostic testing via chorionic villus sampling or amniocentesis (GRADE 1C); (3) we recommend that the accuracy of first-trimester screening tests, including cell-free DNA for aneuploidy, be discussed with patients undergoing or who have undergone in vitro fertilization (GRADE 1A); (4) when multifetal pregnancies do occur, we recommend that counseling be offered regarding the option of multifetal pregnancy reduction (GRADE 1C); (5) we recommend that a detailed obstetrical ultrasound examination (CPT 76811) be performed for pregnancies achieved with in vitro fertilization and intracytoplasmic sperm injection (GRADE 1B); (6) we suggest that fetal echocardiography be offered to patients with pregnancies achieved with in vitro fertilization and intracytoplasmic sperm injection (GRADE 2C); (7) we recommend that a careful examination of the placental location, placental shape, and cord insertion site be performed at the time of the detailed fetal anatomy ultrasound, including evaluation for vasa previa (GRADE 1B); (8) although visualization of the cervix at the 18 0/7 to 22 6/7 weeks of gestation anatomy assessment with either a transabdominal or endovaginal approach is recommended, we do not recommend serial cervical length assessment as a routine practice for pregnancies achieved with in vitro fertilization (GRADE 1C); (9) we suggest that an assessment of fetal growth be performed in the third trimester for pregnancies achieved with in vitro fertilization; however, serial growth ultrasounds are not recommended for the sole indication of in vitro fertilization (GRADE 2B); (10) we do not recommend low-dose aspirin for patients with pregnancies achieved with IVF as the sole indication for preeclampsia prophylaxis; however, if 1 or more additional risk factors are present, low-dose aspirin is recommended (GRADE 1B); (11) given the increased risk for stillbirth, we suggest weekly antenatal fetal surveillance beginning by 36 0/7 weeks of gestation for pregnancies achieved with in vitro fertilization (GRADE 2C); (12) in the absence of studies focused specifically on timing of delivery for pregnancies achieved with IVF, we recommend shared decision-making between patients and healthcare providers when considering induction of labor at 39 weeks of gestation (GRADE 1C).

在过去的几十年中，辅助生殖技术的使用在美国有所增加。尽管这些妊娠中的大多数并不复杂，但体外受精与围产期不良结局的风险增加有关，这主要是由于与体外受精妊娠相关的早产和低出生体重风险增加所致。本咨询讨论了通过体外受精实现的妊娠管理，并根据现有证据提供建议。母胎医学协会的建议如下：（1）我们建议对所有接受或已经接受体外受精（有或没有胞浆内精子注射）的患者进行遗传咨询（GRADE 2C）；（2）无论是否进行了植入前基因检测，我们建议所有通过体外受精实现妊娠的患者都可以通过绒毛膜绒毛取样或羊膜穿刺术进行产前基因筛查和诊断检测（GRADE 1C）；(3) 我们建议与接受或已经接受体外受精的患者讨论妊娠早期筛查测试的准确性，包括非整倍体的无细胞 DNA (GRADE 1A)；(4) 当确实发生多胎妊娠时，我们建议就减少多胎妊娠的选择提供咨询（GRADE 1C）；(5) 我们建议对通过体外受精和胞浆内精子注射（GRADE 1B）实现的妊娠进行详细的产科超声检查（CPT 76811）；（6）我们建议对通过体外受精和胞浆内单精子注射实现妊娠的患者进行胎儿超声心动图检查（GRADE 2C）；(7) 我们建议在详细的胎儿解剖超声检查时仔细检查胎盘位置、胎盘形状和脐带插入部位，包括评估前置血管（GRADE 1B）；(8) 虽然建议在妊娠 18 0/7 至 22 6/7 周使用经腹或阴道内方法进行宫颈可视化评估，但我们不建议将连续宫颈长度评估作为妊娠的常规做法。体外受精（1C 级）；(9) 我们建议在妊娠晚期对通过体外受精获得的妊娠进行胎儿生长评估；然而，不建议将连续生长超声作为体外受精的唯一指征（2B 级）；（10）我们不建议将IVF妊娠的患者小剂量阿司匹林作为子痫前期预防的唯一指征；但是，如果存在 1 个或多个其他风险因素，则建议使用低剂量阿司匹林（GRADE 1B）；(11) 鉴于死产风险增加，我们建议从妊娠 36 0/7 周开始每周进行一次产前胎儿监测，以对通过体外受精获得的妊娠进行妊娠（GRADE 2C）；(12) 由于缺乏专门针对通过 IVF 实现妊娠的分娩时间的研究，我们建议在考虑妊娠 39 周时引产时，患者和医疗保健提供者之间共同决策（GRADE 1C）。