Abstract: Objective　To compare the congenital malformation of the children conceived by assisted reproductive technology（ART） and those conceived spontaneously and to discuss the risks of ART birth defects.Methods　The ART group was consisted of infertility females and their children（12 935 children），using ART at Tianjin Central Hospital of Gynecology Obstetrics during January 2008 to December 2017.The SP group was consisted of fertility females who conceived spontaneously and their children who had congenital anomalies during the same period. The general condition and congenital malformation were compared between ART defects（139 children）and natural conception defects（453 children），and the risk factors of ART birth defects were analyzed. The general condition included gender，gestational age，delivery method，birth weight and malformation of the newborns，as well as fertilization way，maternal age，number of births，pregnancy complications of the mothers.Results　The multiple pregnancy rate，preterm birth rate and the incidence of low birth weight of ART group were all significantly higher than those of SP group，and the average gestational age and average birth weight of ART group were significantly less than those of SP group（P<0.05）.In ART group，the main malformations appeared in cardiovascular system（33.1%），eye，ear，face and neck（13.5%）and other malformations（10.1%）.In vitro fertilization fresh embryo transfer（IVF-ET，40 children），intracytoplasmic sperm injection fresh embryo transfer（ICSI-ET，20 children）and frozen-thawed embryo transfer（FET，79 children）were performed in ART group. IVF-ET，ICSI-ET and FET were found to have cardiovascular malformation as the most common anomaly，while other malformations，cleft lip and palate，eye，ear，face and neck malformation were the less common anomalies respectively.There were no significant differences in malformation distribution of different gender and maternal age in ART group（P>0.05），while the difference in malformation distribution of different gestational age and number of birth in ART group were significant（P<0.05）.In SP group，the main malformations were found in cardiovascular system（62.9%），digestive system（11.1%）and cleft lip and palate（7.0%）.There was no significant difference in malformation distribution of different gender and number of birth in SP group（P>0.05），while the differences in malformation distribution of different gestational age and maternal age were significant in SP group（P<0.05）.The results of multivariate Logistic regression analysis indicated that gestational age，number of fetuses and pregnancy complications were factors influencing the ART birth defects（P<0.05）.Conclusion　The distributions of birth defects are different between ART and SP birth defects，but both indicate high incidence of cardiovascular system defects. Gestational age，number of birth and pregnancy complications are factors influencing the ART birth defects.

Key words: Congenital abnormalities；Reproductive techniques, assisted；Spontaneous pregnancy

摘要： 目的　分析辅助生殖技术（ART）、自然妊娠（SP）子代出生缺陷情况，探讨ART出生缺陷的影响因素。方法　选取2008年1月—2017年12月于天津市中心妇产科医院行ART的孕妇12 935例，其子代为ART出生缺陷儿的有139例（ART组）。同期选取于天津市中心妇产科医院产科分娩的SP出生缺陷儿453例为SP组。收集所有出生儿基本资料，包括出生儿性别、胎龄、出生方式、出生体质量及其母亲年龄、胎数、妊娠期并发症情况，ART方法，出生缺陷儿的畸形部位。结果　ART组胎龄、剖宫产率、出生体质量、母亲妊娠期并发症发生率小于SP组，早产、低出生体量、母亲多胎妊娠发生率大于SP组（P<0.05）。ART组畸形部位构成比前3位是心血管循环系统（33.1%），眼、耳、面、颈部（13.5%），其他畸形（10.1%）。ART方法：体外受精新鲜胚胎移植（IVF-ET）40例，卵细胞浆内单精子注射新鲜胚胎移植（ICSI-ET）20例，解冻复苏胚胎移植（FET）79例。IVF-ET、ICSI-ET、FET出生儿畸形部位构成比第1位均是心血管循环系统，第2位分别是其他畸形，唇腭裂，眼、耳、面、颈部。ART组不同性别、母亲年龄出生儿畸形部位比较，差异无统计学意义（P>0.05）；ART组不同胎龄、母亲胎数出生儿畸形部位分布比较，差异有统计学意义（P<0.05）。SP组畸形部位构成比前3位是心血管循环系统（62.9%），消化系统（11.1%），唇腭裂（7.0%）。SP组不同性别、母亲胎数出生儿畸形部位比较，差异无统计学意义（P>0.05）；SP组不同胎龄、母亲年龄出生儿畸形部位比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，出生儿胎龄、母亲胎数、母亲妊娠期并发症情况是ART出生缺陷的影响因素（P<0.05）。结论　ART、SP出生缺陷儿畸形部位分布存在一定差异，但其最常见的畸形部位均为心血管循环系统；出生儿胎龄、母亲胎数、母亲妊娠期并发症情况均为ART出生缺陷的影响因素。

关键词: 先天畸形；生殖技术, 辅助；自然妊娠