SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Patrick FAURE
Coup de coeur :
 
 
Gut
  2016/05  
 
  2016 May;65(5):767-76  
  doi: 10.1136/gutjnl-2015-311246  
 
  Live birth and adverse birth outcomes in women with ulcerative colitis and Crohn's disease receiving assisted reproduction: a 20-year nationwide cohort study.  
 
  Nørgård BM, Larsen PV, Fedder J, de Silva PS, Larsen MD, Friedman S.  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Live+birth+and+adverse+birth+outcomes+in+women+with+ulcerative+colitis+and+Crohn%27s+disease+receiving+assisted+reproduction%3A+a+20-year+nationwide+cohort+study.  
 
 

OBJECTIVE:

To examine the chance of live births and adverse birth outcomes in women with ulcerative colitis (UC) and Crohn's disease (CD) compared with women without inflammatory bowel disease (IBD) who have undergone assisted reproductive technology (ART) treatments.

METHODS:

This was a nationwide cohort study based on Danish health registries, comprising all women with an embryo transfer during 1 January 1994 through 2013. The cohorts comprised 1360 ART treatments in 432 women with UC, 554 ART treatments in 182 women with CD and 148 540 treatments in 52 489 women without IBD. Our primary outcome was live births per ART treatment cycle. We controlled for multiple covariates in the analyses. Our secondary outcomes were adverse birth outcomes.

RESULTS:

The chance of a live birth for each embryo transfer was significantly reduced in ART treatments in women with UC (OR=0.73, 95% CI 0.58 to 0.92), but not significantly reduced in the full model of ART treatments in women with CD (OR=0.77, 95% CI 0.52 to 1.14). Surgery for CD before ART treatment significantly reduced the chance of live birth for each embryo transfer (OR=0.51, 95% CI 0.29 to 0.91). In children conceived through ART treatment by women with UC, the OR of preterm birth was 5.29 (95% CI 2.41 to 11.63) in analyses including singletons and multiple births; restricted to singletons the OR was 1.80, 95% CI 0.49 to 6.62.

CONCLUSIONS:

Our results suggest that women with UC and CD receiving ART treatments cannot expect the same success for each embryo transfer as other infertile women. Women with CD may seek to initiate ART treatment before needing CD surgery. Increased prenatal observation in UC pregnancies after ART should be considered.

 
Question posée
 
Estimer les taux de natalité et les complications de la grossesse chez les femmes ayant recours à une procréation médicalement assistée (PMA) avec ou sans MICI.
 
Question posée
 
Les femmes avec une MICI ayant recours à une PMA ne peuvent pas espérer le même succès pour chaque transfert d'embryons que les autres femmes infertiles. Une chirurgie pour MC avant PMA réduit de manière significative le risque d'une naissance pour chaque transfert d'embryons ce qui n’est pas le cas dans la RCH. Chez les femmes souffrant RCH le risque d'accouchement prématuré est augmenté au cours de la PMA.
 
Commentaires

Cette étude de cohorte danoise à partir du registre danois de  1994 à 2013, nous apporte des informations solides sur la PMA et ses risques dans cette population de MICI.

 
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