Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2017 Sep;21(18):3998-4006.
To compare obstetrical and neonatal outcomes of twin pregnancies conceived via assisted reproductive technology (ART) with those of naturally conceived ones and to investigate the influence of the ART procedure type on these parameters.
This observational study included 450 ART and 647 spontaneous twin pregnancies delivered over 15 years at a single university-based hospital of Rome, Italy. Logistic and linear regression models adjusted for confounding factors were used to evaluate the effect of ART and the type of assisted conception (IVF/ICSI, ovulation induction ± intrauterine insemination, egg/embryo donation) on maternal and perinatal outcomes.
The mean gestational age was significantly lower in pregnancies conceived via ART. The occurrence rates of gestational diabetes, antenatal admission, prophylactic administration of corticosteroid, very preterm delivery and neonatal intensive care unit admission were higher in the ART group. Twin pregnancies achieved via egg/embryo donation had a lower risk of maternal thrombocytopenia and cervical incompetence and were at greater risk of receiving corticosteroid prophylaxis and patent ductus arteriosus than pregnancies obtained by IVF/ICSI. Conception by ovulation induction was associated with reduced risk of hyperemesis gravidarum and longer neonatal hospitalization compared to pregnancies obtained by IVF/ICSI.
Assisted conception was associated with adverse obstetrical outcomes and lower gestational age, but after adjustment for gestational age neonatal immediate outcomes were similar to those observed in the spontaneous group. There were no many important differences in the outcomes of twin pregnancies obtained by a different type of conception.
比较辅助生殖技术（ART）受孕的双胎妊娠与自然受孕的双胎妊娠的产科和新生儿结局，并探讨ART 程序类型对这些参数的影响。
本观察性研究纳入了意大利罗马一家大学附属医院 15 年间分娩的 450 例 ART 双胎妊娠和 647 例自然双胎妊娠。采用逻辑回归和线性回归模型调整混杂因素，评估 ART 及辅助受孕类型（体外受精/卵胞浆内单精子注射、促排卵±宫腔内人工授精、赠卵/胚胎）对母婴围生期结局的影响。
ART 受孕的妊娠平均胎龄显著较低。ART 组妊娠发生妊娠期糖尿病、产前住院、预防性皮质类固醇治疗、极早产儿分娩和新生儿重症监护病房入院的发生率较高。通过赠卵/胚胎获得的双胎妊娠发生母体血小板减少症和宫颈机能不全的风险较低，而接受皮质类固醇预防和动脉导管未闭的风险较高，与 IVF/ICSI 获得的妊娠相比。与 IVF/ICSI 相比，促排卵妊娠发生妊娠剧吐的风险降低，新生儿住院时间延长。
辅助受孕与不良产科结局和较低的胎龄相关，但调整胎龄后，新生儿即刻结局与自然受孕组相似。不同类型受孕获得的双胎妊娠结局没有太多显著差异。
