Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, Trillium Health Partners, Mississauga, Ontario, Canada.
Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada.
Am J Obstet Gynecol. 2020 Aug;223(2):204.e1-204.e8. doi: 10.1016/j.ajog.2020.02.003. Epub 2020 Feb 14.
The purpose of this study was to conduct a systematic review and meta-analyses of literature regarding the risk of preterm birth in singleton pregnancies after a preterm twin birth.
We conducted a literature search of Embase, Ovid Medline, and Cochrane from inception until February 28, 2019. Studies that evaluated women with a previous twin birth followed by a singleton birth were included.
Data were abstracted in duplicate, and summary odds ratios and confidence intervals were calculated with the use of random effects model. Risk of bias was assessed with the use of the Newcastle-Ottawa Scale, and quality of evidence was evaluated with the use of the Grades of Recommendation, Assessment, Development, and Evaluation approach. The primary outcome was a preterm singleton birth (<37 weeks gestational age); secondary outcomes included risk of late preterm birth (34-36+6 weeks gestation), preterm birth between 30 and 33+6 weeks gestation, and preterm birth at <30 weeks gestation. Subanalysis of risk of singleton preterm birth after spontaneous twin birth was also performed. A priori, the protocol was developed and registered with PROSPERO (2016; registration number: CRD42017053382).
We included 8 cohort studies at low risk-of-bias met inclusion criteria for the systematic review and 6 for the meta-analysis. Compared with women with previous term twin births, women who had previous preterm (<37 weeks gestation) twin births were at increased odds of preterm singleton birth in subsequent pregnancy (odds ratio, 4.34; 95% confidence interval, 2.83-6.65). Gestational age at birth of previous twin pregnancy was an effect modifier. Compared with previous term twin births, the odd ratios of subsequent preterm singleton birth were 2.13 (95% confidence interval, 1.21-3.74) if twins were born between 34 and 36+6 weeks gestation, 5.18 (95% confidence interval, 2.78-9.64) if twins were born between 30 and 33+6 weeks gestation, and 9.78 (95% confidence interval, 4.99-18.98) if twins were born at <30 weeks gestation. A similar trend was seen for the risk of singleton preterm birth after spontaneous twin preterm birth.
A history of preterm twin birth is associated with higher odds of subsequent preterm singleton birth. The odds increase with decreasing gestational age of previous twin birth.
本研究的目的是对既往早产双胞胎分娩后单胎妊娠早产风险的文献进行系统评价和荟萃分析。
我们对 Embase、Ovid Medline 和 Cochrane 进行了文献检索，检索时间从成立至 2019 年 2 月 28 日。纳入评估既往双胎分娩后单胎分娩的女性的研究。
数据由两人独立摘录，并使用随机效应模型计算汇总比值比和置信区间。使用纽卡斯尔-渥太华量表评估偏倚风险，并使用推荐、评估、开发和评估方法评估证据质量。主要结局为早产单胎分娩（<37 孕周）；次要结局包括晚期早产（34-36+6 孕周）、30-33+6 孕周之间的早产和<30 孕周的早产风险。还对自发性双胎早产后单胎早产的风险进行了亚组分析。预先制定了方案，并在 PROSPERO（2016 年；注册号：CRD42017053382）上进行了注册。
我们纳入了 8 项符合纳入标准的低偏倚风险队列研究进行系统评价，6 项进行荟萃分析。与既往足月双胎分娩的女性相比，既往早产（<37 孕周）双胎分娩的女性在随后的妊娠中早产单胎的几率增加（比值比，4.34；95%置信区间，2.83-6.65）。既往双胎妊娠的分娩孕周是一个效应修饰因素。与既往足月双胎分娩相比，如果双胎分娩在 34-36+6 孕周之间，随后早产单胎的比值比为 2.13（95%置信区间，1.21-3.74）；如果双胎分娩在 30-33+6 孕周之间，比值比为 5.18（95%置信区间，2.78-9.64）；如果双胎分娩在<30 孕周，比值比为 9.78（95%置信区间，4.99-18.98）。自发性双胎早产后单胎早产的风险也存在类似的趋势。
既往早产双胞胎分娩与随后早产单胎妊娠的几率增加相关。随着既往双胎分娩孕周的减少，几率增加。
