Salihu Hamisu M, Aliyu Muktar H, Rouse Dwight J, Kirby Russell S, Alexander Greg R
Department of Maternal and Child Health, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
Obstet Gynecol. 2003 Oct;102(4):679-84. doi: 10.1016/s0029-7844(03)00768-3.
To estimate the level of potentially preventable excess mortality achievable by avoiding the creation of higher-order multiple gestation with assisted reproductive technologies.
This was a retrospective cohort study of multiple pregnancies delivered in the United States between 1995 and 1997 involving 304,466 twins, 16,068 triplets, 1448 quadruplets, and 180 quintuplets. We used the generalized estimating equation framework to compute adjusted relative risks for combined perinatal and infant mortality (early mortality). We then calculated potentially preventable excess mortality among higher-order gestations, using twins and triplets sequentially as the referent category.
Early mortality increased significantly with each additional fetus in a dose-dependent fashion (P <.001), corresponding to relative risks (95% confidence interval) of 2.4 (2.2, 2.6) for triplets, 3.3 (2.5, 4.4) for quadruplets, and 10.3 (5.0, 21.4) for quintuplets. The creation of twin rather than quadruplet pregnancies would be associated with a substantially higher level of preventable excess mortality (70%) than the creation of triplet pregnancies (28%). By contrast, limiting quintuplets to twins or triplets did not exhibit a similar level of difference (89% versus 75%, respectively).
Our findings support the need for regulating the number of transferred embryos that result in quadruplet and quintuplet pregnancies.
评估通过避免辅助生殖技术导致高阶多胎妊娠可实现的潜在可预防超额死亡率水平。
这是一项对1995年至1997年在美国分娩的多胎妊娠进行的回顾性队列研究，涉及304,466例双胞胎、16,068例三胞胎、1448例四胞胎和180例五胞胎。我们使用广义估计方程框架来计算围产期和婴儿联合死亡率（早期死亡率）的调整相对风险。然后，我们以双胞胎和三胞胎依次作为参照类别，计算高阶妊娠中潜在可预防的超额死亡率。
早期死亡率随着每增加一个胎儿而显著增加，呈剂量依赖性（P<.001），三胞胎的相对风险（95%置信区间）为2.4（2.2, 2.6），四胞胎为3.3（2.5, 4.4），五胞胎为10.3（5.0, 21.4）。与四胞胎妊娠相比，选择双胞胎妊娠而非四胞胎妊娠可预防的超额死亡率水平（70%）要比选择三胞胎妊娠（28%）高得多。相比之下，将五胞胎限制为双胞胎或三胞胎并没有显示出类似程度的差异（分别为89%和75%）。
我们的研究结果支持有必要对导致四胞胎和五胞胎妊娠的移植胚胎数量进行监管。
