辅助生殖与自然妊娠单胎的母婴情况及6月龄时婴儿体格发育分析

Analysis of maternal and infant status in assisted reproduction or natural singleton pregnancy and infant physical development at the age of 6 months

目的探讨辅助生殖技术(ART)单胎妊娠是否比自然单胎妊娠增加母婴并发症,并在此基础上进一步随访婴儿6月龄时的体格发育。方法回顾性选取2018年1月至2019年6月在我院行IVF术后获得单胎妊娠并分娩的166例患者为ART单胎组。同时选取同时期在我院分娩的自然单胎妊娠166例产妇为自然单胎组,在种族来源、年龄(±2岁)、孕产次、吸烟、饮酒、体重指数(BMI)(±1 kg/m^(2))、孕期体重增加(±2 kg)、分娩时间(1个月内)方面1∶1匹配。比较ART单胎组和自然单胎组的母婴状况;同时随访两组婴儿6月龄时体格发育状况,共收集资料39组。采用Logistic回归模型分析不同妊娠方式的母婴结局的相关影响因素。结果ART单胎组与自然单胎组相比,剖宫产、妊娠期高血压疾病、胎盘前置、胎盘粘连发生率显著升高(P<0.05);两组其它指标(包括分娩孕周、妊娠期糖尿病、宫颈机能不全、胎儿宫内窘迫、孕妇B族链球菌感染、肝功能损害、甲状腺功能异常、胎膜早破、胎盘早剥、羊水过多或羊水过少、产妇入ICU、产后出血等发生率)和新生儿相关指标(包括低体重儿、新生儿入ICU、新生儿窒息、新生儿呼吸窘迫综合征、低血糖、高胆红素血症、溶血、心脏畸形、消化道畸形、泌尿道畸形、肺疾患、神经系统、膈疝等发生率)均无统计学差异(P>0.05)。二元Logistic回归分析显示,剖宫产(OR=5.081,P=0.000)、妊娠期高血压疾病(OR=2.844,P=0.027)、胎盘前置(OR=2.530,P=0.027)、胎盘粘连(OR=2.649,P=0.042)是两种不同妊娠方式围产期并发症的独立影响因素。ART单胎组婴儿6月龄时体重、身长、头围、BMI与自然单胎组婴儿比较均无统计学差异(P>0.05)。结论与自然妊娠单胎相比,ART单胎的剖宫产、妊娠期高血压疾病、胎盘前置、胎盘粘连的发生率较高,但是6月龄时两组婴儿的体格发育无明显差异。

Objective:To explore whether assisted reproductive technology(ART)singleton pregnancy increases maternal and infant complications compared with natural singleton pregnancy,and further follow up the infant physical development at the age of 6 months.Methods:The pregnancy outcomes of 166 patients with IVF singleton pregnancy delivered in Shanghai Xinhua Hospital,Shanghai Jiao Tong University School of Medicine from January 2018 to June 2019 were recruited as ART singleton group.At the same time,166 women with natural singleton pregnancy in our hospital were selected as the natural singleton group.The women of two groups were matched by 1∶1 in terms of ethnic origin,age(±2 years),gravidity or parity,smoking,drinking,body mass index(BMI)(±1 kg/m^(2)),weight gain during pregnancy(±2 kg),time of delivery(within 1 month).The maternal and infant status of ART singleton group and natural singleton group were compared.At the same time,the physical development of infants at the age of 6 months in the two groups were followed up,and a total of 39 sets of data were collected.Logistic regression model was used to analyze the related factors of maternal and infant outcomes in different modes of pregnancy.Results:The rates of cesarean section,hypertensive disorder in pregnancy,placental previa and placental adhesion in ART singleton group were significantly higher than those in natural singleton group(P<0.05).There were no significant differences in other indexes(including gestational weeks of delivery,the rates of gestational diabetes mellitus,cervical insufficiency,fetal distress,maternal group B streptococcus infection,liver dysfunction,thyroid dysfunction,premature rupture of membranes,placental abruption,polyhydramnios or oligohydramnios,maternal entering ICU,postpartum hemorrhage,etc.)and neonatal related indicators(including the rates of low birth weight infants,newborn entering ICU,neonatal asphyxia,neonatal respiratory distress syndrome,hypoglycemia,hyperbilirubinemia,hemolysis,heart malformation,digestive tract malformation,urinary tract malformation,lung disease,nervous system disease,diaphragmatic hernia,etc.)between the two groups(P>0.05).Logistic regression analysis showed that cesarean section(OR=5.081,P=0.000),hypertensive disorder in pregnancy(OR=2.844,P=0.027),placental previa(OR=2.530,P=0.027)and placental adhesion(OR=2.649,P=0.042)were independent influencing factors of perinatal complications(P<0.05).There was no significant difference in body weight,body length,head circumference and BMI between ART singleton group and natural singleton group at the age of 6 months(P>0.05).Conclusions:The incidence of cesarean section,hypertensive disorder in pregnancy,placenta previa and placenta adhesion of ART singleton was significantly higher than that of natural singleton,but there was no significant difference in infant physical development at the age of 6 months between the two groups.