Boulet Sheree L, Schieve Laura A, Nannini Angela, Ferre Cynthia, Devine Owen, Cohen Bruce, Zhang Zi, Wright Victoria, Macaluso Maurizio
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E86, Atlanta, GA 30333, USA.
Hum Reprod. 2008 Aug;23(8):1941-8. doi: 10.1093/humrep/den169. Epub 2008 May 16.
Approximately 18% of multiple births in the USA result from assisted reproduction technology (ART). Although many studies comparing ART and naturally conceived twins report no difference in risks for perinatal outcomes, others report slight to moderate positive or protective associations.
We selected twin deliveries with and without indication of ART from Massachusetts live birth-infant death records from 1997 to 2000 linked to the US ART surveillance system. The sample was restricted to deliveries by mothers with increased socioeconomic status, private health insurance and intermediate/plus prenatal care use. Our final sample included 1446 and 2729 ART and non-ART twin deliveries, respectively. Odds ratios (OR) for associations between ART and perinatal outcomes were adjusted for maternal demographic factors, smoking, prenatal care and hospital care level.
ART twin deliveries were less likely than non-ART to be very preterm (adjusted OR 0.75; 95% confidence interval 0.58-0.97) or include a very low birthweight (<1500 g) infant (0.75; 0.58-0.95) or infant death (0.55; 0.35-0.88). In stratified analyses, these findings were observed among primiparous deliveries, but there were no risk differences among multiparous ART and non-ART twin deliveries.
ART treatment was not a risk factor for adverse perinatal outcome, and risks for several outcomes were somewhat lower among ART twin deliveries. Nonetheless, ART is strongly associated with twinning and twins remain a high-risk group, relative to singletons. Promoting singleton gestation in assisted conception is an important strategy for reducing adverse outcomes.
在美国，约18%的多胞胎分娩是辅助生殖技术（ART）的结果。尽管许多比较ART与自然受孕双胞胎的研究报告称围产期结局风险没有差异，但其他研究报告了轻微到中度的正向或保护性关联。
我们从1997年至2000年与美国ART监测系统相关联的马萨诸塞州活产-婴儿死亡记录中选取了有或无ART指征的双胞胎分娩案例。样本仅限于社会经济地位较高、有私人医疗保险且接受中级/以上产前护理的母亲所分娩的案例。我们的最终样本分别包括1446例ART双胞胎分娩和2729例非ART双胞胎分娩。对ART与围产期结局之间关联的比值比（OR）进行了调整，以考虑母亲的人口统计学因素、吸烟情况、产前护理和医院护理水平。
ART双胞胎分娩比非ART双胞胎分娩更不容易出现极早产（调整后的OR为0.75；95%置信区间为0.58 - 0.97），或包含极低出生体重（<1500克）的婴儿（0.75；0.58 - 0.95），或婴儿死亡（0.55；0.35 - 0.88）。在分层分析中，这些发现见于初产妇分娩，但经产妇ART和非ART双胞胎分娩之间没有风险差异。
ART治疗不是围产期不良结局的危险因素，并且ART双胞胎分娩中几种结局的风险略低。尽管如此，ART与双胞胎出生密切相关，相对于单胎而言，双胞胎仍然是高危群体。在辅助受孕中促进单胎妊娠是减少不良结局的重要策略。
