Luke Barbara, Brown Morton B, Nugent Clark, Gonzalez-Quintero Victor Hugo, Witter Frank R, Newman Roger B
Department of Epidemiology and Public Health, University of Miami School of Medicine, Miami, Florida 33136, USA.
Fertil Steril. 2004 Feb;81(2):315-9. doi: 10.1016/j.fertnstert.2003.07.012.
To evaluate risk factors for adverse outcomes in spontaneous vs. assisted conception twin pregnancies.
Historical cohort study.
Four academic tertiary medical centers.
PATIENT(S): Women with twin pregnancies, including 2,143 spontaneous and 424 assisted conception; 2,492 nonreduced and 75 reduced.
INTERVENTION(S): None (observational).
MAIN OUTCOME MEASURE(S): Preeclampsia, preterm premature rupture of membranes, birth <32 weeks and <30 weeks, low birth weight, very low birth weight, and slowed midgestation fetal growth (<10th percentile between 20 and 28 weeks).
RESULT(S): Among nonreduced pregnancies, assisted conception was not significantly associated with any adverse outcomes; among nulliparas, the risk for preeclampsia was increased regardless of method of conception; among spontaneous conceptions, the risks for preterm premature rupture of membranes, low birth weight, very low birth weight, and slowed midgestation fetal growth were increased. Among all pregnancies, fetal reduction increased risks for birth <32 weeks and <30 weeks, low birth weight, very low birth weight, and slowed midgestation fetal growth. Among nulliparas with assisted conceptions, fetal reduction increased the risks for birth <30 weeks, very low birth weight, and slowed midgestation fetal growth.
CONCLUSION(S): These findings indicate that in twin pregnancies, assisted conception is not a risk factor for adverse outcomes, but rather specific factors that are more common among these pregnancies, such as nulliparity and fetal reduction, increase risks.
评估自然受孕与辅助受孕双胎妊娠不良结局的风险因素。
历史性队列研究。
四家学术性三级医疗中心。
双胎妊娠女性，包括2143例自然受孕者和424例辅助受孕者；2492例未减胎者和75例减胎者。
无（观察性研究）。
子痫前期、胎膜早破、孕周<32周和<30周分娩、低出生体重、极低出生体重以及孕中期胎儿生长缓慢（20至28周时低于第10百分位数）。
在未减胎妊娠中，辅助受孕与任何不良结局均无显著关联；在初产妇中，无论受孕方式如何，子痫前期风险均增加；在自然受孕中，胎膜早破、低出生体重、极低出生体重以及孕中期胎儿生长缓慢的风险增加。在所有妊娠中，减胎会增加孕周<32周和<30周分娩、低出生体重、极低出生体重以及孕中期胎儿生长缓慢的风险。在辅助受孕的初产妇中，减胎会增加孕周<30周分娩、极低出生体重以及孕中期胎儿生长缓慢的风险。
这些发现表明，在双胎妊娠中，辅助受孕不是不良结局的风险因素，而是这些妊娠中更常见的特定因素，如初产和减胎，会增加风险。
