Huiming Yang MD , Haozhe Miao MD , Mengfei Yin MD , Yixuan Wang MD , Dingying Zhao MD , Min Yang MD , Jialin Zou MD , Wenwen Zhang MD , Lingling Zhang MD , Chendan Liu MD , Yue Wang MD , Ze Wang MD , Yunhai Yu MD, PhD , Daimin Wei MD, PhD
{"title":"The difference in early trimester fetal growth between singletons after frozen embryo transfer and fresh embryo transfer","authors":"Huiming Yang MD , Haozhe Miao MD , Mengfei Yin MD , Yixuan Wang MD , Dingying Zhao MD , Min Yang MD , Jialin Zou MD , Wenwen Zhang MD , Lingling Zhang MD , Chendan Liu MD , Yue Wang MD , Ze Wang MD , Yunhai Yu MD, PhD , Daimin Wei MD, PhD","doi":"10.1016/j.xagr.2024.100334","DOIUrl":null,"url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Frozen embryo transfer resulted in a higher birthweight and an increased risk of macrosomia than fresh embryo transfer. However, the mechanism was still unclear. When the impact of frozen embryo transfer on fetal growth began was unknown. Crown-rump length at 11–13 weeks had been regarded as a good indicator of fetal growth in the first trimester and had been used for gestational age calculation in women with uncertain last menstrual periods.</p></div><div><h3>OBJECTIVE</h3><p>To evaluate the association between frozen embryo transfer and early fetal growth, particularly the crown-rump length, then fresh embryo transfer. The secondary objective was to investigate the potential correlation between crown-rump length and birthweight.</p></div><div><h3>STUDY DESIGN</h3><p>This was a retrospective cohort study conducted at the Reproductive Medical Center of Shandong University. A total of 4949 patients who obtained singleton pregnancy after frozen embryo transfer and 1793 patients who got singleton pregnancy after fresh embryo transfer between January 1, 2017 and December 31, 2022 were included. The primary outcome was the crown-rump length measured via ultrasound at 11–13 weeks gestation. The secondary outcomes were perinatal outcomes, including birthweight and the risk of large for gestational age, small for gestational age, macrosomia, low birthweight, and premature delivery. Multivariable linear regression models were used to adjust for potential confounders of crown-rump length.</p></div><div><h3>RESULTS</h3><p>A total of 6742 live singleton births after frozen embryo transfer or fresh embryo transfer were included in this study. In the univariable analysis, the frozen embryo transfer group had a larger crown-rump length (5.75±0.53 cm vs 5.57±0.48 cm, <em>P</em><.001) and an increased risk of larger-than-expected crown-rump length (13.5% vs11.2%, <em>P</em>=.013) than the fresh embryo transfer group. After adjusting for confounders in multivariable linear regression models, frozen embryo transfer was still associated with a larger crown-rump length (regression coefficient, 3.809 [95% confidence intervals, 3.621–3.997], <em>P</em><.001). When subgrouped by fetal gender, the crown-rump length of the frozen embryo transfer group was larger than the fresh embryo transfer group in both male and female fetuses. In addition, the crown-rump length was consistently larger in the frozen embryo transfer group than the fresh embryo transfer group in subgroups of the peak estradiol levels. The comparisons among different crown-rump length groups showed that smaller-than-expected crown-rump length was associated with increased risks of small for gestational age (6.3% vs 3.0%, <em>P</em><.001) and preterm delivery (9.6% vs 6.7%, <em>P</em>=.004) than normal crown-rump length.</p></div><div><h3>CONCLUSION</h3><p>Frozen embryo transfer was associated with a larger crown-rump length than fresh embryo transfer, suggesting that the effect of frozen embryo transfer on fetal growth may begin in the early trimester. Suboptimal fetal growth in the first trimester may be associated with low birthweight and premature delivery.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000285/pdfft?md5=24c86d00a94f2a705efe6756b10cefd6&pid=1-s2.0-S2666577824000285-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"AJOG global reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666577824000285","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
BACKGROUND
Frozen embryo transfer resulted in a higher birthweight and an increased risk of macrosomia than fresh embryo transfer. However, the mechanism was still unclear. When the impact of frozen embryo transfer on fetal growth began was unknown. Crown-rump length at 11–13 weeks had been regarded as a good indicator of fetal growth in the first trimester and had been used for gestational age calculation in women with uncertain last menstrual periods.
OBJECTIVE
To evaluate the association between frozen embryo transfer and early fetal growth, particularly the crown-rump length, then fresh embryo transfer. The secondary objective was to investigate the potential correlation between crown-rump length and birthweight.
STUDY DESIGN
This was a retrospective cohort study conducted at the Reproductive Medical Center of Shandong University. A total of 4949 patients who obtained singleton pregnancy after frozen embryo transfer and 1793 patients who got singleton pregnancy after fresh embryo transfer between January 1, 2017 and December 31, 2022 were included. The primary outcome was the crown-rump length measured via ultrasound at 11–13 weeks gestation. The secondary outcomes were perinatal outcomes, including birthweight and the risk of large for gestational age, small for gestational age, macrosomia, low birthweight, and premature delivery. Multivariable linear regression models were used to adjust for potential confounders of crown-rump length.
RESULTS
A total of 6742 live singleton births after frozen embryo transfer or fresh embryo transfer were included in this study. In the univariable analysis, the frozen embryo transfer group had a larger crown-rump length (5.75±0.53 cm vs 5.57±0.48 cm, P<.001) and an increased risk of larger-than-expected crown-rump length (13.5% vs11.2%, P=.013) than the fresh embryo transfer group. After adjusting for confounders in multivariable linear regression models, frozen embryo transfer was still associated with a larger crown-rump length (regression coefficient, 3.809 [95% confidence intervals, 3.621–3.997], P<.001). When subgrouped by fetal gender, the crown-rump length of the frozen embryo transfer group was larger than the fresh embryo transfer group in both male and female fetuses. In addition, the crown-rump length was consistently larger in the frozen embryo transfer group than the fresh embryo transfer group in subgroups of the peak estradiol levels. The comparisons among different crown-rump length groups showed that smaller-than-expected crown-rump length was associated with increased risks of small for gestational age (6.3% vs 3.0%, P<.001) and preterm delivery (9.6% vs 6.7%, P=.004) than normal crown-rump length.
CONCLUSION
Frozen embryo transfer was associated with a larger crown-rump length than fresh embryo transfer, suggesting that the effect of frozen embryo transfer on fetal growth may begin in the early trimester. Suboptimal fetal growth in the first trimester may be associated with low birthweight and premature delivery.
背景与新鲜胚胎移植相比,冷冻胚胎移植会导致出生体重增加,并增加巨型畸形的风险。然而,其机理尚不清楚。冷冻胚胎移植对胎儿生长的影响何时开始尚不清楚。11-13 周时的头臀长一直被认为是前三个月胎儿生长的良好指标,并被用于计算末次月经不确定的妇女的胎龄。研究设计这是在山东大学生殖医学中心进行的一项回顾性队列研究。共纳入了2017年1月1日至2022年12月31日期间冷冻胚胎移植后获得单胎妊娠的4949例患者和新鲜胚胎移植后获得单胎妊娠的1793例患者。主要结果是妊娠11-13周时通过超声波测量的胎冠臀长。次要结果是围产期结果,包括出生体重和胎龄大、胎龄小、巨大儿、低出生体重和早产的风险。本研究共纳入了 6742 例冷冻胚胎移植或新鲜胚胎移植后的单胎活产。在单变量分析中,与新鲜胚胎移植组相比,冷冻胚胎移植组的冠臀长度更大(5.75±0.53 cm vs 5.57±0.48 cm,P< .001),冠臀长度大于预期的风险更高(13.5% vs 11.2%,P=.013)。在多变量线性回归模型中对混杂因素进行调整后,冷冻胚胎移植仍与冠臀长度增大有关(回归系数,3.809 [95% 置信区间,3.621-3.997],P< .001)。按胎儿性别分组时,无论是男胎还是女胎,冷冻胚胎移植组的冠臀长度均大于新鲜胚胎移植组。此外,在雌二醇峰值分组中,冷冻胚胎移植组的冠臀长度始终大于新鲜胚胎移植组。不同冠臀长度组之间的比较显示,与正常冠臀长度相比,冠臀长度小于预期与胎龄小(6.3% vs 3.0%,P<.001)和早产(9.6% vs 6.7%,P=.004)风险增加有关。妊娠头三个月胎儿发育不良可能与低出生体重和早产有关。
AJOG global reportsEndocrinology, Diabetes and Metabolism, Obstetrics, Gynecology and Women's Health, Perinatology, Pediatrics and Child Health, Urology