自然受孕与辅助生殖技术受孕双胎妊娠的临床特征及母儿结局比较

Clinical features,maternal and neonatal outcomes of twin pregnancies:assisted reproductive technology versus spontaneous conception

目的分析辅助生殖技术(assisted reproductive technology,ART)受孕对双胎妊娠母儿结局的影响。方法选择首都医科大学大兴医院(2014年1月-2016年12月)妇产科和北京万柳美中宜和妇儿医院(2016年1月-2018年12月)妇产科348例双胎妊娠产妇作为研究对象,根据受孕方式不同分为ART受孕组(n=139)和自然受孕对照组(n=209),比较两组孕产妇妊娠相关资料和母儿结局。结果ART受孕组的平均年龄高于对照组[(32.3±4.8)岁vs(30.7±5.5)岁,P=0.006],初产比例高于对照组[120例(86.3%)vs 148例(70.8%),P=0.001],早产率高于对照组[97例(69.8%)vs 118例(56.5%),P=0.012],妊娠期糖尿病占比[52例(37.4%)vs 35例(16.7%),P<0.001]和产后出血发生率[21例(15.1%)vs 17例(8.1%),P=0.041]高于对照组。两组子痫前期、妊娠肝内胆汁淤积症、胎盘早剥、前置胎盘、输血和子宫切除情况差异无统计学意义(P均>0.05)。两组新生儿结局指标差异均无统计学意义(P均>0.05)。结论与自然受孕双胎妊娠孕产妇相比,辅助生殖技术受孕双胎妊娠孕产妇的平均年龄、初产比例、早产率、妊娠期糖尿病占比和产后出血发生率更高。

Objective To analyze the effect of assisted reproductive technology(ART)on maternal and neonatal outcomes of twin pregnancy.Methods Totally 348 women with twin pregnancies from Daxing Hospital of Capital Medical University(from January 2014 to December 2016)and Amcare Women’s and Children’s Hospital at Wanliu(from January 2016 to December 2018)were selected.According to the different ways of conception,they were divided into ART group(n=139)and spontaneous conception group(n=209).The clinical characteristics,maternal and neonatal outcomes of the two groups were compared.Results The average age of the ART group was higher than that of the spontaneous conception group[(32.3±4.8)years vs(30.7±5.5)years,P=0.006],and the proportion of primipara was higher[86.3%vs 70.8%,P=0.001].The preterm birth rate in the ART group was higher than that in the spontaneous conception group[69.8%vs 56.5%,P=0.012],and the incidences of gestational diabetes mellitus(GDM)(37.4%vs 16.7%,P<0.001)and postpartum hemorrhage(15.1%vs 8.1%,P=0.041)were higher than those in the spontaneous conception group.There was no significant difference in the incidence of preeclampsia,ICP,placental abruption,placenta previa,blood transfusion and hysterectomy between the two groups(all P>0.05),and no significant difference was found in neonatal outcomes(all P>0.05).Conclusion In twin pregnancies,women conceived by assisted reproductive technology are older and have higher rate of primipara compared with those having spontaneous conception,meanwhile the incidences of preterm birth rate,GDM and postpartum hemorrhage are also higher.