en ارتباط تکنیک های کمک به باروری با عوارض حاملگی: یک مطالعه مورد-شاهدی گذشته نگر بر اساس جمعیت  Original Article Original Article <strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">مقدمه: </span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">تعداد رو به افزایش از بیماران نابارور از تکنیک&shy;های کمک باروری </span></span><span dir="LTR"><span style="font-size:10.0pt;">ART</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> استفاده می&shy;کنند. توجه به افزایش ریسک عوارض حاملگی در جمعیت </span></span><span dir="LTR"><span style="font-size:10.0pt;">ART</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> در مقایسه با حاملگی طبیعی جلب شده است. </span></span><span style="font-family:b nazanin;"><span style="font-size:14.0pt;"></span></span><br> <strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">هدف:</span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> هدف از انجام مطالعه، بررسی شیوع عوارض حاملگی در </span></span><span dir="LTR"><span style="font-size:10.0pt;">ART</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> و حاملگی طبیعی جهت مطالعه عوارض </span></span><span dir="LTR"><span style="font-size:10.0pt;">ART</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> بر عوارض حاملگی بود. </span></span><span style="font-family:b nazanin;"><span style="font-size:14.0pt;"></span></span><br> <strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">مواد و روش&shy;ها:</span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> یک مطالعه کوهورت گذشته نگر بر اساس جمعیت انجام شد. در این مطالعه 3216 زن حامله که به کلینیک زنان پس از زایمان مراجعه کردند شزکت داده شدند. ما شیوع عوارض حاملگی را در گروه&shy;ها و زیرگروه&shy;های مختلف بررسی کردیم.</span></span><span style="font-family:b nazanin;"><span style="font-size:14.0pt;"></span></span><br> <strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">نتایج: </span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">یک تفاوت معنی&shy;داری در سن متوسط (037/0=</span></span><span dir="LTR"><span style="font-size:10.0pt;">p</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">) </span></span><span dir="LTR"><span style="font-size:10.0pt;">BMI</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> متوسط قبل حاملگی (014/0=</span></span><span dir="LTR"><span style="font-size:10.0pt;">p</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">)، سن حاملگی (017/0=</span></span><span dir="LTR"><span style="font-size:10.0pt;">p</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">)، میزان تولد زنده (0/000=</span></span><span dir="LTR"><span style="font-size:10.0pt;">p</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">)، شیوع دیابت حاملگی (</span></span><span dir="LTR"><span style="font-size:10.0pt;">GDM</span></span><span style="font-family:b mitra;"><span style="font-size:10.0pt;">)</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> (p=0/002</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">)، پره اکلامپسی </span></span><span dir="LTR"><span style="font-size:10.0pt;">PE</span></span><span style="font-family:b mitra;"><span style="font-size:10.0pt;">)&nbsp;</span></span><span dir="RTL"></span><font face="B Mitra"><span style="font-size: 14.545454025268555px;">(p=0/000</span></font><span style="font-family:b mitra;"><span style="font-size:11.0pt;">&nbsp;</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">، کلستاز داخل کبدی حاملگی (</span></span><span dir="LTR"><span style="font-size:10.0pt;">ICP</span></span><span style="font-family:b mitra;"><span style="font-size:10.0pt;">)</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> (p=0/000</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">)، پارگی زودرس کیسه آب (</span></span><span dir="LTR"><span style="font-size:10.0pt;">PROM)</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> (p=0/000</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">) و پلاسنتا پرویا (0/008=</span></span><span dir="LTR"><span style="font-size:10.0pt;">p</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">) بین گروه </span></span><span dir="LTR"><span style="font-size:10.0pt;">ART</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> با گروه حاملگی طبیعی بود. در حالیکه تفاوت معناداری در شیوع ناهنجاری&shy;های مادرزادی بین دو گروه نبود (0/065=</span></span><span dir="LTR"><span style="font-size:10.0pt;">p</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">). حاملگی چندقلویی یک ریسک فاکتور در </span></span><span dir="LTR"><span style="font-size:10.0pt;">GDM</span></span><span style="font-family:b mitra;"><span style="font-size:10.0pt;">،</span></span> <span dir="LTR"><span style="font-size:10.0pt;">PE</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> و </span></span><span dir="LTR"><span style="font-size:10.0pt;">ICP</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> بود. </span></span><span dir="LTR"><span style="font-size:10.0pt;">Gn</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> یک ریسک فاکتور در </span></span><span dir="LTR"><span style="font-size:10.0pt;">GDM</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">، </span></span><span dir="LTR"><span style="font-size:10.0pt;">PE</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> و </span></span><span dir="LTR"><span style="font-size:10.0pt;">ICP</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> بود. درمان با پروژسترون اثری روی </span></span><span dir="LTR"><span style="font-size:10.0pt;">GDM</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">، </span></span><span dir="LTR"><span style="font-size:10.0pt;">PE</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> و </span></span><span dir="LTR"><span style="font-size:10.0pt;">ICP</span></span><span style="font-family:b mitra;"><span style="font-size:10.0pt;"> نداشت.</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"></span></span><br> <strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">نتیجه&shy;گیری:</span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> شیوع </span></span><span dir="LTR"><span style="font-size:10.0pt;">GDM</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">، </span></span><span dir="LTR"><span style="font-size:10.0pt;">PE</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">، </span></span><span dir="LTR"><span style="font-size:10.0pt;">ICP</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">، </span></span><span dir="LTR"><span style="font-size:10.0pt;">PROM</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> و پلاسنتا پرویا به طور معناداری در گروه </span></span><span dir="LTR"><span style="font-size:10.0pt;">ART</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> بالاتر است. در حالیکه اختلافی در شیوع </span></span><span dir="LTR"><span style="font-size:10.0pt;">GDM</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">، </span></span><span dir="LTR"><span style="font-size:10.0pt;">PE</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> و </span></span><span dir="LTR"><span style="font-size:10.0pt;">ICP</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">بین انتقال امبریو تازه یا یخ زده و آب شده مشاهده نشد. چندقلویی و استفاده از </span></span><span dir="LTR"><span style="font-size:10.0pt;">Gn</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> ریسک فاکتور </span></span><span dir="LTR"><span style="font-size:10.0pt;">GDM</span></span><span style="font-family:b mitra;"><span style="font-size:10.0pt;">،</span></span> <span dir="LTR"><span style="font-size:10.0pt;">PE</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> و </span></span><span dir="LTR"><span style="font-size:10.0pt;">ICP</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">می&shy;باشد.&nbsp;</span></span><strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;"></span></span></strong> <strong>Background:</strong> More and more infertile patients have accepted the assisted reproductive technique (ART) therapy. Concerns have been raised over an increased risk of adverse maternal outcomes in ART populations as compared with natural conception (NC).<br> <strong>Objective:</strong> The aim was to improve the ART in clinicial work and to reduce the incidence of pregnancy complications in ART group according to analyzing the reasons of high incidence of pregnancy complications in ART group, comparing the incidence of pregnancy complications in different controlled ovarian hyperstimulation (COH) programs and evaluating the effects of ART which attribute to adverse pregnancy outcomes.<br> <strong>Materials and Methods:</strong> In this prospective population-based cohort study,3216 pregnant women with gestational age &le;12 weeks, regular antenatal examination,and ultrasound identification of intrauterine pregnancy were enrolled from January 2010 to June 2013. According to having ART history, the participantswere divided into two groups: ART group (contains fresh embryo transfer group or frozen-thawed embryo transfer group) and NC group. We compared the incidence of pregnancy complications between different groups and evaluated the factors which could affect the occurrence of these complications.<br> <strong>Results: </strong>When compared to NC group, significantly increased rates of gestational diabetes mellitus (GDM) (p<0.01), preeclampsia (PE) (p<0.01) and intrahepatic cholestasis of pregnancy (ICP) (p˂0.01) were observed in ART group. There was no significant difference in the incidence of birth defect between the two groups (p=0.07). Multiple pregnancies and Gonadotropin (Gn) were risk factors in GDM, PE, and ICP. The exogenous progesterone treatment had no effect on GDM, PE or ICP.<br> <strong>Conclusion: </strong>ART increases the risk of adverse maternal complications such as GDM, PE and ICP. The dosages of Gn should be reduced to an extent and the number of embryo implantation should be controlled. Exogenous progesterone treatment is safe. ناباروری, روش کمک ناباروری, عوارض بارداری. Infertility, Assisted reproductive technique, Pregnancy complications 169 180 http://ijrm.ir/browse.php?a_code=A-10-1-261&slc_lang=en&sid=1 Zhang Jie No Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China Ding Yiling dingyilingcsu@sina.cn Yes Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China Yu Ling No Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China