辅助生殖技术双胎受孕后不良妊娠结局风险评价的Meta分析

Risk evaluation on adverse pregnancy outcomes of twin pregnancies by assisted reproductive technology: a meta-analysis

目的评价辅助生殖技术双胎受孕不良妊娠结局的风险。方法检索Pub Med、Cochrane图书馆、Google学术、中国生物医学文献数据库、万方数据资源系统、中国知网、重庆维普数据库。检索日期截至2015年6月。按照预先设定的标准检索、筛选、纳入和分析文献。用随机效应模型或固定效应模型对各个研究报告的结果进行合并,计算合并相对危险度(RR)及相应95%的可信区间(CI)。通过亚组分析识别异质性调节因子。采用漏斗图和Egger检验分析潜在的发表偏倚。结果最初共检索到3 432篇文献,最终纳入32篇文献,涉及33 465例辅助生殖技术受孕双胎和99 089例自然受孕双胎。Meta分析结果提示辅助生殖技术双胎受孕与自然双胎受孕比较早产(RR=1.08,95%CI:1.02~1.15)、低出生体重(RR=1.05,95%CI:1.01~1.08)、极低出生体重(RR=1.12,95%CI:1.00~1.26)和先天畸形(RR=1.12,95%CI:1.02~1.24)的风险分别增加8%、5%、12%和12%。尚未发现极早产(RR=1.13,95%CI:0.99~1.29)、胎儿子宫内生长受限(RR=1.21,95%CI:0.94~1.57)、小于胎龄儿(RR=0.87,95%CI:0.70~1.09)、围产期死亡(RR=1.00,95%CI:0.82~1.21)和新生儿呼吸窘迫综合征(RR=0.99,95%CI:0.64~1.54)的风险在两组间存在差异。漏斗图和Egger检验(P≥0.124)提示无发表偏倚。结论辅助生殖技术双胎受孕不良妊娠结局的风险高于自然双胎受孕。

Objective To assess the risk of adverse pregnancy outcomes of twin pregnancies by assisted reproductive technology （ ART）. Methods PubMed, Cochrane Libraries, Google Scholar, CBMdisc, Wangfang Data, CNKI and VIP were searched till June 2015 to identify studies that met pre-stated inclusion criteria. Either a fixedor a random-effects model was used to calculate the overall combined risk estimates and 95% confidence interval （ C1）. Subgroup analysis was performed to explore potential heterogeneity moderators. Funnel plot and Egger regression analysis were used to assess publication bias. Results Thirty-two literatures involving 33,465 twins conceived by ART and 99,089 twins conceived naturally were included from 3,432 literatures initially searched. Meta analysis revealed that the ART twin births had respectively a 8%, 5%, 12% and 12% increased risk of preterm birth （RR=1.08, 95%CI：1.02-1.15）, low birth weight （RR= 1.05, 95%CI：1.01- 1.08）, very low birth weight （RR= 1.12, 95% CI： 1.00-1.26） and congenital malformations （RR = 1.12, 95% CI： 1.02 - 1.24） as compared with the naturally conceived twins. No statistically significant difference was found in the risk of very preterm birth （ RR = 1.13, 95% CI： 0.99 - 1.29 ） , intrauterine growth restriction （ RR= 1.21, 95%CI：0.94- 1.57 ） , small size for gestational age （ RR= 0.87, 95%CI：0.70- 1.09 ） , perinatal mortality （ RR = 1.00, 95 % CI： 0. 82 - 1.21 ） and neonatal respiratory distress syndrome （ RR = 0.99, 95 % CI： 0.64 - 1.54 ） between the two groups. Funnel plot and Egger test （ P≥0. 124 ） indicated that there was no publication bias. Conclusions Twin pregnancies conceived by ART are at increased risk for adverse pregnancy outcomes compared with those conceived naturally.