孕前超重/肥胖对IVF-ET助孕双胎妊娠结局的影响

The impact of preconception overweight/obesity on the outcomes of twin pregnancies assisted by IVF-ET

目的探讨女性孕前超重/肥胖对IVF-ET助孕双胎妊娠结局的影响。方法回顾性分析2019年1月至2021年12月于西北妇女儿童医院分娩的IVF-ET双胎妊娠孕妇的临床资料。共纳入研究对象806例,并根据孕前体质量指数(BMI)不同将研究对象分为超重/肥胖组(BMI≥24 kg/m^(2),264例)和正常组(18 kg/m^(2)<BMI<24 kg/m^(2),542例)。比较两组患者的一般资料、妊娠结局指标。结果两组患者的一般资料比较,除学历分布、不良孕产史比例、初次怀孕比例有显著性差异(P<0.05)外,其余指标(包括年龄、高龄孕妇比例等)均无显著性差异(P>0.05)。超重/肥胖组的妊娠期高血压疾病发生率显著高于正常组(21.97%vs.11.07%,P<0.05),其中子痫前期发生率显著高于正常组(7.58%vs.4.24%,P<0.05);超重/肥胖组的妊娠期糖尿病发生率亦显著高于正常组(46.21%vs.30.26%,P<0.05)。两组的分娩孕周以及妊娠期贫血、妊娠期甲状腺疾病、胎膜早破、产后出血等发生率比较均无显著性差异(P>0.05)。多因素Logistic回归分析发现,孕前超重/肥胖会增加IVF-ET助孕双胎妊娠妇女妊娠期高血压疾病[OR=2.19,95%CI(1.46,3.28)]和妊娠期糖尿病[OR=2.07,95%CI(1.52,2.83)]的发病风险(P<0.05)。结论通过IVF-ET治疗获得双胎妊娠的孕妇中,孕前超重/肥胖是妊娠期高血压疾病(特别是子痫前期)和妊娠期糖尿病的危险因素。超重/肥胖患者进行IVF-ET助孕前应指导其采取相应措施合理减重,适时开始IVF-ET;进入治疗周期后,如获得双胎妊娠,应严密监测产检各项指标,重点关注孕妇的血压及血糖水平,有效预防不良妊娠结局发生。

Objective:To explore the impact of preconception overweight/obesity on the outcomes of twin pregnancies assisted by IVF-ET.Methods:A retrospective analysis was conducted on the clinical data of women who had twin pregnancies assisted by IVF-ET and delivered at Northwest Women and Children’s Hospital from January 2019 to December 2021.According to preconception body mass index(BMI),a total of 806 women were included and divided into overweight/obesity group(BMI≥24 kg/m^(2),n=264)and normal group(18 kg/m^(2)<BMI<24 kg/m^(2),n=542).The basic characteristics and pregnancy outcomes were compared between two groups.Results:There were significant differences in the educational level,adverse pregnancy history and the number of pregnancy(P<0.05)and no significant differences in other basic characteristics including age and the proportion of women with advanced maternal age(P>0.05)between the two groups.The incidence of hypertensive disorders of pregnancy(21.97%vs.11.07%,P<0.05),preeclampsia(7.58%vs.4.24%,P<0.05)and gestational diabetes mellitus(46.21%vs.30.26%,P<0.05)in the overweight/obese group were significantly higher than those in the normal group.There were no significant differences in gestational age and the incidence of gestational anemia,gestational thyroid disease,premature rupture of membrane and postpartum hemorrhage between the two groups(P>0.05).Multivariate logistic regression analysis showed that preconception overweight/obesity would increase the risk of hypertensive disorders of pregnancy[OR=2.19,95%CI(1.46,3.28)]and gestational diabetes mellitus[OR=2.07,95%CI(1.52,2.83)]in women with twin pregnancies assisted by IVF-ET(P<0.05).Conclusions:Preconception overweight/obesity is a risk factor for hypertension disorders of pregnancy(especially preeclampsia)and gestational diabetes mellitus in women with twin pregnancies assisted by IVF-ET.Overweight/obese patients should be guided to take appropriate measures to reduce weight and undergo IVF-ET at an appropriate time.After the begin of the treatment cycle,if twin pregnancies are obtained,various indicators of prenatal examination should be closely monitored,with a focus on blood pressure and blood sugar levels,so as to effectively prevent adverse pregnancy outcomes.