体外受精与自然受孕后消失的双胞胎妊娠的相关围产因素。
Associated perinatal determinants of vanishing twin pregnancies achieved by in vitro fertilization vs. spontaneous conception.
机构信息
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Szeged, Semmelweis u. 1., 6725, Szeged, Hungary.
Center for Assisted Reproduction, Kaáli Institute, Csongrádi sgt. 21., Szeged, 6723, Hungary.
出版信息
Arch Gynecol Obstet. 2020 Feb;301(2):491-498. doi: 10.1007/s00404-020-05448-y. Epub 2020 Feb 5.
PURPOSE
To evaluate whether vanishing twin (VT) pregnancies following spontaneous conception have a more adverse perinatal outcome than those conceived after assisted reproduction techniques.
METHODS
The retrospective cohort study consisted of 316 VT pregnancies derived from a hospital database between January 1994 and January 2016 (81 after IVF/ICSI and 235 after spontaneous conception).
RESULTS
VT was significantly more prevalent after spontaneous conception (in 22.0% of twins) than after IVF/ICSI (in 14.5% of twins). VT pregnancies were significantly more associated with pre-gestational and gestational diabetes mellitus (GDM) in IVF/ICSI pregnancies compared to those spontaneously conceived [adjusted odds ratio (AOR): 4.12 and 11.1, respectively]. IVF-related placental insertion abnormalities were significantly higher in VT pregnancies. A high risk for VT was recorded in the spontaneous group for those who had previously undergone an induced abortion (AOR 0.56) or second-trimester fetal loss (AOR 0.67). The VT phenomenon was a major prognosticator of intrauterine growth retardation (IUGR) for the remaining fetus in IVF pregnancies (AOR 5.12). After controlling for covariates conjointly, advanced age (AOR 1.3), GDM (AOR 2.1), hypertensive disorders (AOR 3.5), primiparity (AOR 3.8), and placentation anomalies all represented independent risk factors for VT in IVF pregnancies.
CONCLUSIONS
IVF/ICSI poses a higher risk for an adverse perinatal outcome following VT pregnancies as compared with those spontaneously conceived.
目的
评估自然受孕后发生的消失的双胞胎（VT）妊娠与辅助生殖技术受孕后相比是否具有更不利的围产期结局。
方法
本回顾性队列研究纳入了 1994 年 1 月至 2016 年 1 月期间一个医院数据库中的 316 例 VT 妊娠（81 例来自 IVF/ICSI，235 例来自自然受孕）。
结果
与 IVF/ICSI 相比（在 14.5%的双胞胎中），自然受孕后 VT 更为常见（在 22.0%的双胞胎中）。与自然受孕相比，IVF/ICSI 妊娠中 VT 与孕前和妊娠期糖尿病（GDM）显著相关[校正优势比（AOR）分别为 4.12 和 11.1]。IVF 相关的胎盘插入异常在 VT 妊娠中明显更高。对于先前经历过人工流产（AOR 0.56）或中期胎儿丢失（AOR 0.67）的自然受孕组，VT 风险较高。对于 IVF 妊娠，VT 现象是剩余胎儿宫内生长迟缓（IUGR）的主要预后因素（AOR 5.12）。在共同控制协变量后，高龄（AOR 1.3）、GDM（AOR 2.1）、高血压疾病（AOR 3.5）、初产妇（AOR 3.8）和胎盘异常均代表 IVF 妊娠中 VT 的独立危险因素。
结论
与自然受孕相比，IVF/ICSI 后 VT 妊娠的围产期结局不良风险更高。
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