Younis Johnny S, Issawy Mariana, Izhaki Ido, Ben-Shlomo Izhar, Soltsman Sofia, Perlitz Yuri, Ben-Ami Moshe, Brenner Benjamin, Sarig Galit
Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch Padeh Medical Center, 15208, Poriya, Israel.
Azrielli Faculty of Medicine in Galilee, Bar-Ilan University, Safed, Israel.
Arch Gynecol Obstet. 2021 Jun;303(6):1549-1555. doi: 10.1007/s00404-020-05959-8. Epub 2021 Feb 9.
Protein C global assay tests the global function of the protein C pathway, the most clinically significant anticoagulant pathway in humans. The objective of this study is to assess the difference in protein C global assay levels, throughout twin gestation, in naturally conceiving and ART-treated women.
This is a prospective cohort longitudinal study of pregnant women with twin gestation. Protein C Global evaluation was performed on frozen blood samples. Ninety-eight women with twin pregnancy, thirty-eight naturally conceived and sixty following ART, were evaluated on four occasions: during the first, second, and third trimesters, and 6 weeks or later after delivery (baseline).
Protein C global assay levels were lower throughout pregnancy as compared to basal levels in both the naturally conceived and ART-conceived groups. However, protein C global assay levels were similar between the ART-conceived and naturally conceived twin pregnancies in all three trimesters. Perinatal complications were associated with decreased protein C global assay levels during the third trimester, although no difference was encountered between naturally conceived and ART-complicated twin pregnancies.
While protein C global assay levels drop during twin pregnancy, there is no difference between ART-conceived and naturally conceived gestations. Decreased levels of protein C global assay during the third trimester were similarly associated with perinatal complications in both groups. Our results imply that twin pregnancy of itself is a more dominant factor for perinatal complications as compared to other factors, such as subfertility or the exposure to ART per se.
蛋白C总体测定可检测蛋白C途径的整体功能，该途径是人类临床上最重要的抗凝途径。本研究的目的是评估自然受孕和接受辅助生殖技术（ART）治疗的双胎妊娠女性在整个孕期中蛋白C总体测定水平的差异。
这是一项对双胎妊娠孕妇进行的前瞻性队列纵向研究。对冷冻血样进行蛋白C总体评估。98例双胎妊娠女性，其中38例自然受孕，60例接受ART治疗，在四个时间点进行评估：孕早期、孕中期、孕晚期以及产后6周或更晚（基线）。
与自然受孕组和ART受孕组的基础水平相比，整个孕期蛋白C总体测定水平均较低。然而，在所有三个孕期中，ART受孕的双胎妊娠和自然受孕的双胎妊娠之间的蛋白C总体测定水平相似。围产期并发症与孕晚期蛋白C总体测定水平降低有关，尽管自然受孕和ART相关并发症的双胎妊娠之间未发现差异。
虽然双胎妊娠期间蛋白C总体测定水平会下降，但ART受孕和自然受孕的妊娠之间没有差异。在两组中，孕晚期蛋白C总体测定水平降低同样与围产期并发症有关。我们的结果表明，与其他因素（如生育力低下或ART本身的暴露）相比，双胎妊娠本身是围产期并发症的更主要因素。
