辅助生殖技术下双绒毛三羊膜囊三胎妊娠的发生率及其相关危险因素：大样本临床数据分析。
Pregnancy incidence and associated risk factors of dichorionic triamniotic triplet under assisted reproduction: A large sample of clinical data analysis.
机构信息
Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Department of Obstetrics and Gynecology, Anhui Province Maternity and Child Health Hospital, Hefei, China.
出版信息
Front Endocrinol (Lausanne). 2023 Mar 17;14:1049239. doi: 10.3389/fendo.2023.1049239. eCollection 2023.
BACKGROUND
Dichorionic triamniotic (DCTA) triplet pregnancies are rare in spontaneous pregnancy. The aim was to characterize the incidence and risk factors of DCTA triplet pregnancies after assisted reproductive technology (ART).
METHODS
A retrospective analysis of 10,289 patients, including 3,429 fresh embryo transfer (ET) cycle and 6,860 frozen ET cycle, was performed from January 2015 to June 2020. The effect of different ART parameters on the incidence of DCTA triplet pregnancies was evaluated by multivariate logistic regression analyses.
RESULTS
Among all clinical pregnancies after ART, the incidence of DCTA was 1.24%. 1.22% occurred in the fresh ET cycle, while 1.25% occurred in the frozen ET cycle. The number of ET and cycle type has no effect on the occurrence of DCTA triplet pregnancies ( = 0.987; = 0.056, respectively). There were significant differences in DCTA triplet pregnancies rate among receiving intracytoplasmic sperm injection (ICSI) and receiving fertilization (IVF) [1.92% vs. 1.02%, < 0.001, = 0.461, 95% confidence interval (CI) 0.315-0.673], blastocyst transfer (BT) versus cleavage-ET (1.66% vs. 0.57%, < 0.001, = 0.329, 95% CI 0.315-0.673), and maternal age ≥ 35 years versus maternal age < 35 years (1.00% vs. 1.30%, = 0.040, = 1.773, 95% CI 1.025-3.066). Based on the regression analysis of cycle type, DCTA triplet pregnancies rate was higher in maternal age < 35 years than in maternal age ≥ 35 years (1.35% vs. 0.97%, < 0.001, = 5.266, 95% CI 2.184-12.701), BT versus cleavage-ET (1.47% vs. 0.94%; 0.006, = 0.346, 95% CI 0.163-0.735), and receiving ICSI was higher than receiving IVF (3.82% vs. 0.78%, < 0.001, = 0.085, 95% CI 0.039-0.189) in fresh ET cycle. However, DCTA triplet pregnancies rate did not show difference in maternal age, insemination methods, and number of ET, and only BT was found to be associated with a higher DCTA triplet pregnancies rate in the frozen ET cycle (1.73% vs. 0.30%, < 0.001, = 0.179, 95% CI 0.083-0.389).
CONCLUSION
The prevalence of DCTA triplet pregnancies has increased after ART. Maternal age < 35 years, BT, and receiving ICSI are risk factors for DCTA triplet pregnancies, also in fresh ET cycle. However, in frozen ET cycle, BT is an independent risk factor for increased DCTA triplet pregnancies rate.
背景
自然妊娠中双绒毛膜三羊膜囊（DCTA）三胎妊娠较为罕见。本研究旨在探讨辅助生殖技术（ART）后 DCTA 三胎妊娠的发生率及相关危险因素。
方法
回顾性分析了 2015 年 1 月至 2020 年 6 月期间 10289 例患者的资料，包括 3429 例新鲜胚胎移植（ET）周期和 6860 例冷冻 ET 周期。采用多因素 logistic 回归分析不同 ART 参数对 DCTA 三胎妊娠发生率的影响。
结果
在所有 ART 后的临床妊娠中，DCTA 的发生率为 1.24%。新鲜 ET 周期中发生率为 1.22%，冷冻 ET 周期中发生率为 1.25%。ET 数量和周期类型对 DCTA 三胎妊娠的发生无影响（ = 0.987； = 0.056）。接受胞浆内单精子注射（ICSI）和接受体外受精（IVF）的 DCTA 三胎妊娠发生率存在显著差异[1.92% vs. 1.02%， < 0.001， = 0.461，95%置信区间（CI）0.315-0.673]；囊胚移植（BT）和卵裂期 ET 比较[1.66% vs. 0.57%， < 0.001， = 0.329，95% CI 0.315-0.673]；母亲年龄≥35 岁与母亲年龄<35 岁比较[1.00% vs. 1.30%， = 0.040， = 1.773，95% CI 1.025-3.066]。基于周期类型的回归分析显示，母亲年龄<35 岁时 DCTA 三胎妊娠发生率高于母亲年龄≥35 岁（1.35% vs. 0.97%， < 0.001， = 5.266，95% CI 2.184-12.701），BT 与卵裂期 ET 比较[1.47% vs. 0.94%； < 0.001， = 0.346，95% CI 0.163-0.735]，接受 ICSI 与接受 IVF 比较[3.82% vs. 0.78%， < 0.001， = 0.085，95% CI 0.039-0.189]。然而，在新鲜 ET 周期中，母亲年龄、授精方法和 ET 数量与 DCTA 三胎妊娠发生率无差异，仅 BT 与 DCTA 三胎妊娠发生率较高相关（1.73% vs. 0.30%， < 0.001， = 0.179，95% CI 0.083-0.389）。
结论
ART 后 DCTA 三胎妊娠的发生率有所增加。母亲年龄<35 岁、BT 和接受 ICSI 是 DCTA 三胎妊娠的危险因素，在新鲜 ET 周期中也是如此。然而，在冷冻 ET 周期中，BT 是增加 DCTA 三胎妊娠发生率的独立危险因素。
Zotero 插件