The Risk Of Spontaneous Preterm Birth In Singleton Pregnancy After Assisted Reproductive Technology:A Meta-analysis

Objective: To explore the risk of spontaneous preterm birth in singleton pregnancy after assisted reproductive technology.Methods:PubMed,ScienceDirect,Springerlink,Wiley Online Library,Medline,Embase database and CNKI,VIP journal database(VIP),Wanfang database were searched comprehensively by computer and supplemented by manual retrieval.Chinese and English cohort studies on the risk of spontaneous preterm birth(SPTB)in singleton pregnancies resulting from assisted reproductive technology(ART)as compared to spontaneous conception(SC)were included.The retrieval time is from January 1,1990 to January 1,2019.Literature screening and data extraction were carried out according to inclusion and exclusion criteria.After evaluating the heterogeneity of the articles,the fixed or random effects model was used to calculate the results.Stata 12.0 SE software was used for meta-analysis.Result:A total of 22 cohort studies were included.The literature included 16928 pregnant women with single pregnancy after assisted reproductive technology(ART)and 650084 pregnant women with single pregnancy after spontaneous conception(SC).Meta-analysis showed that ART single-pregnancy had a higher risk of spontaneous preterm birth than SC single-pregnancy(OR =1.49,95% CI = 1.39-1.60,z = 11.18,P = 0.000),and the difference was statistically significant.Subgroup analysis based on ART type,the Meta-analysis of 14 studies showed that single pregnancy after IVF had a higher risk of spontaneous preterm birth than spontaneous conception(OR =1.49,95% CI = 1.39-1.60,z = 11.18),P = 0.000).Meta-analysis of 7 studies showed that single pregnancy after IVF/ICSI had a higher risk of spontaneous preterm birth than spontaneous conception(OR = 1.564,95% CI = 1.197-2.042,z = 3.28,P = 0.001).A qualitative analysis of 2 studies revealed a positive correlation between single pregnancy after ICSI and spontaneous preterm birth.Conclusions:1.Single-pregnancy after assisted reproductive technology(IVF/ICSI)has a higher risk of spontaneous preterm birth than SC single-pregnancy.2.The risk of spontaneous preterm birth of single-pregnancy after IVF is increased.3.Qualitative analysis of two literatures which explicitly proposed the use of ICSI shows that there is a positive correlation between single-pregnancy after ICSI and spontaneous preterm birth.