Luke Barbara, Gopal Daksha, Cabral Howard, Stern Judy E, Diop Hafsatou
Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI.
Department of Biostatistics, Boston University School of Public Health, Boston, MA.
Am J Obstet Gynecol. 2017 Sep;217(3):330.e1-330.e15. doi: 10.1016/j.ajog.2017.04.025. Epub 2017 Apr 25.
It is unknown whether the risk of adverse outcomes in twin pregnancies among subfertile women, conceived with and without in vitro fertilization, differs from those conceived spontaneously.
We sought to evaluate the effects of fertility status on adverse perinatal outcomes in twin pregnancies on a population basis.
All twin live births of ≥22 weeks' gestation and ≥350 g birthweight to Massachusetts resident women in 2004 through 2010 were linked to hospital discharge records, vital records, and in vitro fertilization cycles. Women were categorized by their fertility status as in vitro fertilization, subfertile, or fertile, and by twin pair genders (all, like, unlike). Women whose births linked to in vitro fertilization cycles were classified as in vitro fertilization; those with indicators of subfertility but without in vitro fertilization treatment were classified as subfertile; all others were classified as fertile. Risks of 6 adverse pregnancy outcomes (gestational diabetes, pregnancy hypertension, uterine bleeding, placental complications [placenta abruptio, placenta previa, and vasa previa], prenatal hospitalizations, and primary cesarean) and 9 adverse infant outcomes (very low birthweight, low birthweight, small-for-gestation birthweight, large-for-gestation birthweight, very preterm [<32 weeks], preterm, birth defects, neonatal death, and infant death) were modeled by fertility status with the fertile group as reference, using multivariate log binomial regression and reported as adjusted relative risk ratios and 95% confidence intervals.
The study population included 10,352 women with twin pregnancies (6090 fertile, 724 subfertile, and 3538 in vitro fertilization). Among all twins, the risks for all 6 adverse pregnancy outcomes were significantly increased for the subfertile and in vitro fertilization groups, with highest risks for uterine bleeding (adjusted relative risk ratios, 1.92 and 2.58, respectively) and placental complications (adjusted relative risk ratios, 2.07 and 1.83, respectively). Among all twins, the risks for those born to subfertile women were significantly increased for very preterm birth and neonatal and infant death (adjusted relative risk ratios, 1.36, 1.89, and 1.87, respectively). Risks were significantly increased among in vitro fertilization twins for very preterm birth, preterm birth, and birth defects (adjusted relative risk ratios, 1.28, 1.07, and 1.26, respectively).
Risks of all maternal and most infant adverse outcomes were increased for subfertile and in vitro fertilization twins. Among all twins, the highest risks were for uterine bleeding and placental complications for the subfertile and in vitro fertilization groups, and neonatal and infant death in the subfertile group. These findings provide further evidence supporting single embryo transfer and more cautious use of ovulation induction.
对于通过体外受精和未通过体外受精受孕的不育妇女，双胎妊娠不良结局的风险是否与自然受孕的妇女不同尚不清楚。
我们试图在人群基础上评估生育状况对双胎妊娠围产期不良结局的影响。
2004年至2010年马萨诸塞州常住妇女中所有妊娠≥22周且出生体重≥350克的双胎活产与医院出院记录、生命记录和体外受精周期相关联。妇女按生育状况分为体外受精、不育或可育，按双胎性别（全部、同性、异性）分类。与体外受精周期相关的分娩妇女被分类为体外受精；有不育指标但未接受体外受精治疗的妇女被分类为不育；所有其他妇女被分类为可育。以可育组为参照，采用多变量对数二项回归模型分析6种不良妊娠结局（妊娠期糖尿病、妊娠高血压、子宫出血、胎盘并发症[胎盘早剥、前置胎盘和帆状胎盘]、产前住院和初次剖宫产）和9种不良婴儿结局（极低出生体重、低出生体重、小于胎龄出生体重、大于胎龄出生体重、极早产[<32周]、早产、出生缺陷、新生儿死亡和婴儿死亡）的风险，并报告调整后的相对风险比和95%置信区间。
研究人群包括10352例双胎妊娠妇女（6090例可育、724例不育和3538例体外受精）。在所有双胎中，不育组和体外受精组的所有6种不良妊娠结局风险均显著增加，子宫出血风险最高（调整后的相对风险比分别为1.92和2.58），胎盘并发症风险最高（调整后的相对风险比分别为2.07和1.83）。在所有双胎中，不育妇女所生双胎的极早产、新生儿和婴儿死亡风险显著增加（调整后的相对风险比分别为1.36、1.89和1.87）。体外受精双胎的极早产、早产和出生缺陷风险显著增加（调整后的相对风险比分别为1.28、1.07和1.26）。
不育和体外受精双胎的所有母亲和大多数婴儿不良结局风险均增加。在所有双胎中，不育组和体外受精组子宫出血和胎盘并发症风险最高，不育组新生儿和婴儿死亡风险最高。这些发现为支持单胚胎移植和更谨慎使用促排卵提供了进一步证据。
