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5000试管婴儿历时13年随访:易出现糖尿病,体重代谢异常

2018-09-28 佚名 健康界

你也许想不到,近几年我国出生的人口中,有将近2%是通过辅助生育技术才来到这个世界上的。根据国家统计局的数据,我国2016年出生人口1723万人,其中通过辅助生殖技术出生的人口超过31万,约占1.7%。 这是一个非常庞大的数字。那么,这些通过助孕手段出生的人们,和自然受孕出生的人们,到底有没有区别?

你也许想不到,近几年我国出生的人口中,有将近2%是通过辅助生育技术才来到这个世界上的。根据国家统计局的数据,我国2016年出生人口1723万人,其中通过辅助生殖技术出生的人口超过31万,约占1.7%。 这是一个非常庞大的数字。那么,这些通过助孕手段出生的人们,和自然受孕出生的人们,到底有没有区别?

上个周末,第四届辅助生殖质量控制学术研讨会在杭州召开,中国科学院院士黄荷凤教授、大会主席及浙大妇院辅助生殖中心主任朱依敏教授等着重关注到这个问题,并一致提出,辅助生殖技术的研究目标,已从初期的“提高成功率”转变为现在的“出生健康子代”。

浙大妇院于2005年起着手开展试管婴儿健康的调查,至今已经对5000多例试管婴儿进行长期跟踪随访,朱依敏教授接受快报记者采访,披露了一些他们及全国、全世界同行观察到的结论。

体外操作、促排卵药物 会对孩子的长远有影响?

世界上第一例试管婴儿1978年出生在英国,是一名女性,叫路易斯·布朗。对于这些人为提取精子、卵子,或人为配成胚胎发育而来的群体,他们成人后是否健康?与常人有否不同?全世界的辅助生殖专家们为此开始了至今已40年的观察。

目前得出的结论是:

1.通过辅助生殖技术出生的孩子,从外观上看,与正常出生的孩子差异不大。

2.通过辅助生殖技术出生的孩子,在发育过程中体重、新陈代谢可能会受到影响,他们到了一定年龄后,血脂、血糖代谢异常的比例会增加,糖尿病高血压、高血脂的发病率会增高。

3.这些异常不是父母基因里带来的毛病,有可能是和辅助生殖技术中的体外操作及宫内不良环境有关。

比如,第一例试管婴儿,现在已经40岁的路易斯·布朗就有代谢问题,很胖,但她父母并没有代谢方面的疾病。浙大妇院1996年体外培养的第一例试管婴儿,今年22岁,也存在肥胖的问题。

那么,体外操作和宫内不良环境为什么会影响到精子、卵子或者胚胎呢?

朱教授说,这一方面和现在辅助生殖技术中卵子、精子和胚胎接触的培养液和培养器皿有一定的关系。

“精子和卵子取出后,都要放到培养皿中,接触到培养液等。现在的培养皿都是塑制品,塑料的成分双苯酚属于环境雌激素,对配子(精子、卵子)或胚胎可能造成潜在影响。所以,操作人员哪怕只是不小心在培养皿上轻轻划了一道,释放出的双苯酚都可能影响到这个试管婴儿的一生。”

另一方面,和女性促排卵时需要激素刺激,需要使用相关药物有关。人为激素调整会引起女性体内促性腺激素和性激素的改变,这些改变使女性体内环境对卵子和胚胎可能造成潜在影响。

45岁以上的男性,不建议通过辅助生殖技术要孩子。

影响辅助生育质量控制的,还有试管婴儿父母们本身的健康问题。父母本身健康状况不太好的,调整后再做试管婴儿比较好。

比如,本身肥胖的父母,通过辅助生殖技术出生的孩子,不仅有再次发生肥胖的风险,智商也会相对有所下降。

“比如,本来可以生出智商120的孩子,现在可能只有110。”朱教授说。

除了环境因素,子代的健康也和父母的年龄和体质等相关。美国医学会精神病学杂志(The Journal of the American Medical Association psychiatry,JAMA psychiatry)指出,与子代出生时父亲的年龄为20-24岁比较,倘若其父亲≥45岁时生下的孩子,发生自闭症的风险增加3.45倍,多动症的风险增加13.13倍,患有双情感障碍可高达24.7倍,企图自杀风险是2.72倍,药物滥用的危险增加2.44倍。

“父母年龄对子代的影响,浙大妇院也在做相关的研究。尤其是实施二孩政策以来,高龄夫妇想通过辅助生殖技术再要一个孩子的需求大量增加。但我们要对生出来的孩子的健康负责,对整体人口素质负责。45岁以上的女性,我们不建议她们再要孩子了。而45岁以上的男性生的孩子健康问题也是值得关注的。”朱教授说。

双胎保险是不得已,单胎妊娠对孩子才是最好的。

辅助生殖技术出生人口中,双胎比例是显着增高的。这是因为,体外培养的胚胎移植到母体子宫的时候,为增加妊娠概率,有时候会移入两个胚胎。两个胚胎都存活的话,很可能就会生下双胞胎。

“但事实上,双胞胎肯定会存在这样那样的问题的。营养上肯定会不足,会早产,会先天发育不良,更容易发生代谢问题等,对社交能力、精细动作上都会有一定影响,没有单胎孩子灵活,动作协调性没那么好等等。”朱依敏教授说。

尤其重点要告诉大家的是,先植入双胎,哪怕后面再减胎,对孩子的出生也是有影响的。浙大妇院做过一千多例从双胎或三胎减到单胎的,但这些孩子的健康还是比不过一开始就只植入一个胚胎的。

“欧洲国家已有些立法,要求选择性单胚胎移植。也就是说,母体年纪轻、身体条件比较好、子宫条件比较好、怀孕概率比较高、胚胎移入子宫后容易存活的,那就只能移植一个胚胎。如果移两个,会受罚。这项立法其实就是不希望国家整体人口素质受到影响。”朱教授解释。

我国2003年起有相关规定:小于35周岁且第1次做试管婴儿的女性,植入胚胎时不能超过两个;35周岁以上或者第2次做试管婴儿的,植入胚胎不能超过3个。

“2003年的时候我国辅助生殖技术尚在起步阶段,怕胚胎移入子宫后存活不了,所以规定比较宽泛,但现在的技术水平是显着提高了。对医生来说,促成单卵泡发育成熟、单胎妊娠才是最好的,水平最高的。”

促排卵过程中,卵泡发育过多的那些女性,对她本身的甲状腺功能也会有一定影响,血脂、血管功能会有些变化。

全国有300多家生殖中心能做试管婴儿,但能自然生尽量自然生。

朱依敏教授说,到2017年底,全国已有478个生殖中心,300多家能做试管婴儿。光统计2012年-2016年,浙大妇院就有两万多例试管婴儿诞生。非常难的夫妻双方都有不孕不育因素的病例,现在也可以通过辅助生殖技术生下宝宝了。

比如朱教授最近碰到一例,妻子是染色体问题导致的早发性卵巢功能不全,丈夫患梗阻性无精症,最终朱教授也通过对男方睾丸活检取精冻精、对女方多次取卵冻卵,再进行“第三代”试管婴儿技术帮这位妻子成功植入了一枚染色体核型正常的胚胎,目前已经怀孕近3个月。

在技术水平越来越高的发展趋势下,质量控制管理就显得相当重要。

“我们会对药物的使用、父母年龄、纠正父母病理状态,控制辅助生育适应证等方面进行更为严格的质控。能自然怀孕的,我们还是建议尽量自然怀孕。一般情况下,自然怀孕的孩子受外界因素的影响总是要少一些。”

加强辅助生殖技术的质量控制管理,降低出生缺陷风险、提高出生人口素质成为当今生殖医学领域和卫生行政管理的当务之急。

试管婴儿如何在长大成人的过程中,预防并尽量减少代谢异常的风险?

既然试管婴儿出生的孩子,因为辅助生殖技术中的体外操作及宫内不良的环境,会增加代谢异常的风险。

那么,如何在他(她)长大成人的过程中预防并尽量减少风险?

朱教授说,准妈妈可以从孕前就进行干预,孕中发现不合适,可以做补救措施,孩子出生后,坚持门诊随访,及时发现问题解决问题。

孕前干预,要控制多卵泡的发育,减少胚胎移植数目,进行选择性单胚胎移植。

孕期,如果发现宫内双胎或双胎以上多胎妊娠,及时做补救措施,该减胎就要减胎。

试管婴儿出生后,每半年到一年定期随访体检,观察孩子的生长发育情况。一旦在随访中发现孩子超重,或者存在一些血脂血糖偏高的迹象,及时调整饮食,合理运动,把风险扼杀在萌芽状态。

“我们随访的5000多例试管婴儿出生的孩子,都是定期到随访门诊检查,看看身高是不是达标、有没有超重、血常规血生化看看血脂血糖等情况,同时还给他们做智力测定,目的是让孩子健康成长。”

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    2019-03-11 ying_wu
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    2018-12-02 jyzxjiangqin

    糖尿病患者的病因的影响。

    0

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    2018-11-05 jyzxjiangqin

    试管婴儿历时13年随访。

    0

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    2018-10-09 122a54f7m32(暂无昵称)

    好文章

    0

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    2018-09-29 1209e435m98(暂无昵称)

    我认为代谢异常是后天导致的,与试管婴儿技术本身关联不大。试想不孕父母好不容易得到孩子,必定是好吃好喝供着的,营养过剩等饮食起居习惯恐是主因。

    0

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    2018-09-28 1e1b8538m79(暂无匿称)

    不错的文章值得拥有哦

    0

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    2018-09-28 misszhang

    谢谢MedSci提供最新的资讯

    0

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    2018-09-28 医者仁心5538

    学习了

    0

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