A Case-control Study On The Association Between Assisted Reproductive Technology And White Matter Damage In Premature Infants

Objectives : It is yet unclear whether there is a link between assisted reproductive technology(ART)and brain damage in premature infants.The aim of this study was to determine whether premature infants conceived by ART have a greater risk of developing white matter damage(WMD)than those naturally conceived(NC),and to compare the difference of distribution type of WMD.Methods:A retrospective study was conducted in Shengjing Hospital of China Medical University from January 2017 to December 2019,which included 638 live-born singleton premature infants with a gestational age of ≥28 weeks and <34 weeks.According to the presence or absence of WMD,they were divided into case group or control group.According to the conception method,they were divided into ART group or NC group.The study not only compared the difference of general situation of premature infants,but also the proportion and distribution type of white matter damage.Finally,a logistic regression model was used to explore whether ART is an independent risk factor for WMD.Results:1)The study included 218 cases in the case group and 420 cases in the control group.The proportion of asphyxia in premature infants in the case group was higher(31.7% vs.22.4%,P<0.05),and the proportion of invasive ventilation was higher(43.1%vs.29.3%,P<0.05).The proportion of gestational hypertension of the mothers in the case group was lower than that in the control group(20.2% vs.31.7%,P<0.05).The proportion of gestational diabetes of the mothers in the case group was higher than that in the control group(29.4% vs.22.1%,P<0.05),and the proportion of ART conception was higher than that in the control group(12.8% vs.7.4%,P<0.05).2)The study included 59 cases in the ART group and 579 cases in the control group.There was no significant difference in the gestational age,birth weight,length,head circumference,chest circumference,proportion of asphyxia,proportion of SGA and LGA between the two groups(P>0.05).3)Mothers in the ART group were older than those in the NC group(33 vs.30,P<0.05).The former had a higher proportion of primiparity(91.5% vs.66.8%,P<0.05)and gestational diabetes(40.7% vs.23.1%,P<0.05).4)The proportion of white matter damage in the ART group was higher(47.5% vs.32.8%,P<0.05).The proportion of PWMD in the ART group was higher(47.5% vs.32.1%,P<0.05),and the proportion of DWMD was not statistically different between the two groups(P>0.05).5)The PWMD of the ART group and the NC group were both mainly point lesions.The proportions of point,cluster,and linear lesions in the two groups were 67.9% vs.71.0%,21.4% vs.22.0%,and 10.7% vs.7.0%.The difference was not statistically significant(P>0.05).6)ART conception was an independent risk factor for WMD(P<0.05).After adjusting for gestational age,SGA,asphyxia,invasive ventilation,maternal age,gestational hypertension,and gestational diabetes,the odds ratio of ART conception was1.779,95% confidence interval,1.021-3.102.Conclusions : Singleton premature infants conceived by ART have a higher risk of WMD than those naturally conceived,and WMD in the two groups show similar distribution type.Both groups are mainly point lesions,followed by cluster lesions,and linear lesions are the least.In addition,ART is an independent risk factor for WMD in premature infants,and more attention should be paid to the development of the nervous system of this population.