辅助生殖技术双胎妊娠对新生儿结局的影响

Influence of twin pregnancy by assisted reproductive technology on neonatal outcomes

摘要:

目的 比较辅助生殖技术（ART）双胎妊娠与自然受孕（SC）双胎妊娠对新生儿结局的影响。方法 回顾性纳入南京市妇幼保健院2017~2019年期间分娩的胎龄≥ 24周活产双胎儿3 356例，其中ART组双胎儿2 006例（1 003对），SC组双胎儿1 350例（675对），收集母亲一般资料、妊娠期合并症及新生儿一般资料、新生儿疾病及结局，进行两组间比较。结果 ART组母亲平均年龄大于SC组（P < 0.05），初产率、剖宫产率及宫颈环扎手术率高于SC组（P < 0.05）。ART组母亲妊娠相关合并症，如高血压、糖尿病及产后出血发生率均高于SC组（P < 0.05）。ART组新生儿平均胎龄低于SC组（P < 0.05），极低出生体重儿比例高于SC组（6.8% vs 5.8%，P < 0.05），但ART未增加早产及低Apgar评分的风险。两组新生儿的病死率及新生儿疾病，如呼吸窘迫综合征、Ⅱ/Ⅲ期坏死性小肠结肠炎、支气管肺发育不良、Ⅲ~Ⅳ级颅内出血的发生率差异均无统计学意义（P > 0.05）。结论 与SC双胎妊娠相比，ART双胎妊娠未明显增加新生儿病死率及不良结局。

Abstract:

Objective To study the influence of twin pregnancy by assisted reproductive technology (ART) versus twin pregnancy by spontaneous conception (SC) on neonatal outcomes. Methods A retrospective analysis was performed for the clinical data of 3 356 live twins with a gestational age of ≥24 weeks who were born in Nanjing Maternal and Child Health Hospital from 2017 to 2019, with 2 006 twins (1 003 pairs) in the ART group and 1 350 (675 pairs) in the SC group. The two groups were compared in terms of the mother's general information and pregnancy comorbidities and the general information, diseases, and outcomes of neonates. Results Compared with the SC group, the ART group had a significantly higher maternal age (P < 0.05) and significantly higher rates of primiparity, cesarean section, and cervical cerclage (P < 0.05). Compared with the SC group, the ART group had significantly higher incidence rates of maternal pregnancy comorbidities including hypertension, gestational diabetes, and postpartum hemorrhage (P < 0.05). Compared with the SC group, the ART group had a significantly lower mean gestational age of neonates (P < 0.05) and a significantly higher proportion of very-low-birth-weight infants (6.8% vs 5.8%, P < 0.05), while ART did not increase the risks of preterm birth and low Apgar score. There were no significant differences between the two groups in the mortality rate of neonates and the incidence rates of neonatal diseases including respiratory distress syndrome, stage II/III necrotizing enterocolitis, bronchopulmonary dysplasia, and grade III-IV intracranial hemorrhage (P > 0.05). Conclusions Compared with twin pregnancy by SC, twin pregnancy by ART does not increase the neonatal mortality rate and risk of adverse outcomes.