Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital - Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):10213-10219. doi: 10.1080/14767058.2022.2122806. Epub 2022 Sep 13.
To compare adverse pregnancy and neonatal outcomes in twin pregnancies conceived by fertilization (IVF) to those conceived spontaneously.
Retrospective analysis of the Centers for Disease Control and Prevention, Natality Live Birth database for the years 2016-2019. All twin live births were included and stratified into two groups: those from pregnancies conceived IVF and those from pregnancies conceived spontaneously. The incidence of several adverse pregnancy and neonatal outcomes were compared between the two groups. Statistical analysis included multivariable logistic regression to adjust for the following potential confounders: maternal age, race/ethnicity, body mass index, education level, type of medical insurance, chronic hypertension, pregestational diabetes, and prior preterm birth. Data were presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI).
Twin live births from pregnancies conceived IVF comprised 9.5% of the study cohort (39,356 of 415,560). Baseline characteristics varied significantly between IVF and spontaneously conceived twins. After adjusting for these variables, IVF in twins was associated with an increased risk of multiple adverse outcomes including gestational diabetes (aOR = 1.35, 95% CI = 1.30-1.39), hypertensive disorders of pregnancy (aOR = 1.70, 95% CI = 1.65-1.75), preterm birth prior to 28 weeks (aOR = 1.53, 95% CI = 1.43-1.63), maternal intensive care unit admission (aOR = 2.03, 95% CI = 1.79-2.31), maternal blood transfusion (aOR = 2.97, 95% CI = 2.75-3.20), unplanned hysterectomy (aOR = 3.37, 95% CI = 2.73-4.16), and prolonged ventilation in newborns (aOR = 1.76, 95% CI = 1.69-1.82), compared to spontaneously conceived twin pregnancies.
Based on this large United States population-based cohort, twin pregnancies conceived IVF represent a subgroup of twins that have an increased risk for several adverse pregnancy and neonatal outcomes, compared to those conceived spontaneously. With increased contemporary utilization of IVF, obstetricians should consider these risks while caring for patients with twin pregnancies conceived IVF.
比较通过体外受精（IVF）受孕的双胞胎妊娠与自然受孕的双胞胎妊娠的不良妊娠和新生儿结局。
回顾性分析 2016 年至 2019 年美国疾病控制与预防中心国家生命统计数据库中的数据。纳入所有双胞胎活产，并分为两组：IVF 受孕组和自然受孕组。比较两组的几种不良妊娠和新生儿结局的发生率。统计分析包括多变量逻辑回归，以调整以下潜在混杂因素：产妇年龄、种族/民族、体重指数、教育水平、医疗保险类型、慢性高血压、孕前糖尿病和既往早产。数据以调整后的优势比（aOR）和 95%置信区间（CI）表示。
IVF 受孕的双胞胎活产占研究队列的 9.5%（41556/415560）。IVF 受孕和自然受孕的双胞胎之间的基线特征差异显著。调整这些变量后，IVF 受孕的双胞胎发生多种不良结局的风险增加，包括妊娠期糖尿病（aOR=1.35，95%CI=1.30-1.39）、妊娠高血压疾病（aOR=1.70，95%CI=1.65-1.75）、28 周前早产（aOR=1.53，95%CI=1.43-1.63）、产妇入住重症监护病房（aOR=2.03，95%CI=1.79-2.31）、产妇输血（aOR=2.97，95%CI=2.75-3.20）、非计划子宫切除术（aOR=3.37，95%CI=2.73-4.16）和新生儿延长通气时间（aOR=1.76，95%CI=1.69-1.82），与自然受孕的双胞胎妊娠相比。
基于这项美国大型基于人群的队列研究，与自然受孕的双胞胎妊娠相比，通过 IVF 受孕的双胞胎妊娠是一组具有多种不良妊娠和新生儿结局风险增加的亚组。随着当代 IVF 应用的增加，产科医生在为 IVF 受孕的双胞胎妊娠患者提供护理时应考虑这些风险。
