Martínez-Varea Alicia, Martínez-Gómez Martha, Novillo Blanca, Domenech Josep, Morales-Roselló José, Diago-Almela Vicente
Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain.
Department of Economics and Social Sciences, Universitat Politècnica de València, Camí de Vera s/n, 46022 Valencia, Spain.
J Clin Med. 2023 Sep 21;12(18):6097. doi: 10.3390/jcm12186097.
: It has been reported that monochorionic twin pregnancies conceived through assisted reproductive techniques (ART) display a higher risk of second-trimester miscarriage, cesarean delivery, and neonatal death than those conceived naturally. The aim of this study was to compare the perinatal outcomes of monochorionic diamniotic (MCDA) twin pregnancies conceived naturally and through ART in a tertiary hospital. : This was a retrospective cohort study of all MCDA twin pregnancies that received obstetric care and delivered at La Fe University and Polytechnic Hospital between 2015 and 2021. MCDA pregnancies that were referred to the tertiary hospital for specialized management, follow-up, and delivery were also included. The study was approved by The Health Research Institute Hospital La Fe (IIS La Fe). : Among the 184 MCDA pregnancies, 149 (81%) had a natural conception, and 35 (19%) were conceived through ART. Patients with an MCDA pregnancy who conceived through ART had a significantly older maternal age (38.0 [35.5-42.5] vs. 32.0 [29.0-36.0], 0.001) and an elevated rate of nulliparity (80.0% vs. 50.3%, = 0.001). Regarding pregnancy complications, MCDA pregnancies through ART were associated with a significantly higher incidence of gestational diabetes (22.9% vs. 2.7%, 0.001), hypertensive disorders during pregnancy (22.9% vs. 9.4%, = 0.04), and other pregnancy complications such as threatened labor or preterm prelabor rupture of membranes (14.3% vs. 36.2%, = 0.015), than naturally conceived MCDA pregnancies. No differences were found in the incidence of twin-to-twin transfusion syndrome (20% vs. 33.6%, = 0.155). MCDA pregnancies through natural conception had a greater rate of vaginal delivery than MCDA through ART (16.8% vs. 2.9%, = 0.032). When adjusted for confounding factors, MCDA pregnancies through ART were only more likely to develop gestational diabetes than those naturally conceived (aOR 7.86, 95% CI 1.55-39.87). No differences were found regarding neonatal outcomes between groups. : Compared with naturally conceived MCDA twin pregnancies, those conceived through ART displayed a significantly higher risk of developing gestational diabetes. No differences regarding other pregnancy complications, mode of delivery, or neonatal outcomes were found between groups.
据报道，通过辅助生殖技术（ART）受孕的单绒毛膜双胎妊娠，与自然受孕的相比，在孕中期流产、剖宫产和新生儿死亡方面风险更高。本研究的目的是比较在一家三级医院中，自然受孕和通过ART受孕的单绒毛膜双羊膜囊（MCDA）双胎妊娠的围产期结局。
这是一项回顾性队列研究，研究对象为2015年至2021年间在拉费大学理工医院接受产科护理并分娩的所有MCDA双胎妊娠。还纳入了因专科管理、随访和分娩而转诊至三级医院的MCDA妊娠。该研究获得了拉费医院健康研究所（IIS La Fe）的批准。
在184例MCDA妊娠中，149例（81%）为自然受孕，35例（19%）为通过ART受孕。通过ART受孕的MCDA妊娠患者的产妇年龄显著更大（38.0[35.5 - 42.5]岁对32.0[29.0 - 36.0]岁，P = 0.001），未生育比例更高（80.0%对50.3%，P = 0.001）。关于妊娠并发症，与自然受孕的MCDA妊娠相比，通过ART受孕的MCDA妊娠发生妊娠期糖尿病的发生率显著更高（22.9%对2.7%，P = 0.001）、妊娠期高血压疾病（22.9%对9.4%，P = 0.04）以及其他妊娠并发症如先兆临产或胎膜早破（14.3%对36.2%，P = 0.015）。双胎输血综合征的发生率未发现差异（20%对33.6%，P = 0.155）。自然受孕的MCDA妊娠阴道分娩率高于通过ART受孕的MCDA妊娠（16.8%对2.9%，P = 0.032）。在对混杂因素进行校正后，通过ART受孕的MCDA妊娠仅比自然受孕的更易发生妊娠期糖尿病（调整后比值比7.86，95%置信区间1.55 - 39.87）。两组间新生儿结局未发现差异。
与自然受孕的MCDA双胎妊娠相比，通过ART受孕的发生妊娠期糖尿病的风险显著更高。两组间在其他妊娠并发症、分娩方式或新生儿结局方面未发现差异。
