Data_Sheet_1_Effects of gestational diabetes mellitus and assisted reproductive technology treatment on the risk of preterm singleton birth.docx

BackgroundAlthough assisted reproductive technology (ART) plays a critical role in reducing infertility, ART pregnant women are reported at higher risk of preterm birth (PTB). Besides, women undergoing ART encounter a higher risk of developing gestational diabetes mellitus (GDM). However, existing studies on the combined effect of ART treatment and GDM on PTB risk are sparse.
MethodsThis population-based retrospective cohort study used nationwide birth certificate data from the US National Vital Statistics System 2015-2019. All mothers who had a singleton live birth without pre-pregnancy diabetes were included. Multivariable logistic regression models were used to estimate the odds ratio (OR) of PTB.
ResultsWe finally included 18,140,241 American mother-infant pairs. The overall rate of PTB was 7.92% (n = 1,436,328). The PTB rate for non-ART mothers without GDM, ART mothers without GDM, non-ART mothers with GDM, and ART mothers with GDM were 7.67, 10.90, 11.23, and 14.81%, respectively. The incidence of GDM in ART mothers (10.48%) was significantly higher than in non-ART mothers (6.26%). After adjusting for potential confounders, compared with non-ART mothers without GDM, the PTB risk was significantly increased for ART mothers without GDM (AOR: 1.47, 95% CI 1.44-1.50), non-ART mothers with GDM (AOR:1.35, 95% CI 1.34-1.36) and ART mothers with GDM (AOR: 1.82, 95% CI 1.74-1.90) respectively, showing an increasing tendency. This phenomenon was stable among mothers in all groups of mothers older than 25 years.
ConclusionTo prevent PTB, effective approaches for the prevention of GDM are crucial to mothers who conceived through ART.

背景：尽管辅助生殖技术（assisted reproductive technology, ART）在不孕症诊疗中发挥着关键作用，但现有研究显示，接受ART的孕妇发生早产（preterm birth, PTB）的风险显著升高。此外，接受ART辅助受孕的女性罹患妊娠期糖尿病（gestational diabetes mellitus, GDM）的风险也显著增加。然而，目前针对ART治疗与GDM联合暴露对早产风险影响的相关研究仍较为匮乏。
方法：本研究为基于人群的回顾性队列研究，采用美国国家生命统计系统2015-2019年的全国出生登记数据。研究纳入所有孕前无糖尿病、分娩单活胎的产妇。采用多变量logistic回归模型估算早产的比值比（odds ratio, OR）。
结果：本研究最终纳入18140241对美国母婴队列。总体早产率为7.92%（n=1436328）。无GDM的非ART产妇、无GDM的ART产妇、伴GDM的非ART产妇以及伴GDM的ART产妇的早产率分别为7.67%、10.90%、11.23%和14.81%。ART产妇的GDM发生率（10.48%）显著高于非ART产妇（6.26%）。在校正潜在混杂因素后，相较于无GDM的非ART产妇，无GDM的ART产妇（校正后比值比（adjusted odds ratio, AOR）:1.47, 95%置信区间（confidence interval, CI）:1.44-1.50）、伴GDM的非ART产妇（AOR:1.35, 95%CI:1.34-1.36）以及伴GDM的ART产妇（AOR:1.82, 95%CI:1.74-1.90）的早产风险均显著升高，且呈现逐步升高的趋势。该现象在25岁以上的所有亚组产妇中均保持稳定。
结论：为降低早产发生风险，对于通过ART辅助受孕的产妇而言，采取有效措施预防妊娠期糖尿病至关重要。