摘要
目的 观察并比较辅助生殖技术(ART)助孕双绒毛膜双胎与自然妊娠双绒毛膜双胎孕妇的妊娠结局。方法 回顾性分析2019年3月至2022年12月在山西省汾阳医院/山西医科大学附属汾阳医院住院分娩的200例双绒毛膜双羊膜囊双胎孕妇的临床资料。根据受孕方式不同分为ART组(64例)和自然妊娠组(136例),比较两组的基础资料、妊娠期并发症发生情况和新生儿结局;又根据颈项透明层检查建档时孕妇体质量指数(BMI)不同对研究对象进行分层,分为正常体重(BMI 18.5~24.9 kg/m2)、超重(BMI 25.0~27.9 kg/m2)和肥胖(BMI≥28.0 kg/m2)人群,比较正常体重组和超重肥胖组的妊娠期并发症发生情况。结果 除ART组患者年龄显著高于自然妊娠组(P<0.05)外,两组的孕次、初产妇比例、BMI等均无显著性差异(P>0.05)。ART组的妊娠期高血压疾病(46.88%vs. 28.68%)、妊娠期糖尿病(GDM)发生率(42.19%vs. 22.79%)显著高于自然妊娠组(P<0.05);两组患者早产、贫血、产后出血、前置胎盘等的发生率均无显著性差异(P>0.05)。ART组和自然妊娠组的新生儿出生体重及低出生体重儿、缺血缺氧性脑病等新生儿不良结局发生率比较均无显著性差异(P>0.05)。ART组中超重肥胖亚组患者的妊娠期高血压疾病(58.97%vs. 28.00%)、GDM发生率(56.41%vs. 20.00%)显著高于正常体重亚组(P<0.05);自然妊娠组中超重肥胖亚组患者的妊娠期高血压疾病(37.50%vs. 18.75%)、GDM(31.94%vs. 12.50%)及早产发生率(16.67%vs. 1.56%)显著高于正常体重亚组(P<0.05);ART组中超重肥胖亚组的妊娠期高血压疾病(58.97%vs. 37.50%)、GDM发生率(56.41%vs. 31.94%)显著高于自然妊娠组中的超重肥胖亚组(P<0.05)。结论 与自然妊娠双绒毛膜双胎孕妇相比,ART助孕双绒毛膜双胎孕妇的妊娠期高血压疾病、GDM发生率明显升高,但不能排除年龄因素的影响;不管是自然受孕双绒毛膜双胎妊娠还是ART助孕双绒毛膜双胎妊娠,超重或肥胖都与妊娠期并发症的发生风险增高有关。
Objective:To observe and compare pregnancy outcomes of women with dichorionic twins conceived by ART and spontaneous dichorionic twins.Methods:A retrospective analysis was conducted on the clinical data of 200 pregnant women with dichorionic twins who were hospitalized and delivered at Shanxi Fenyang Hospital from March 2019 to December 2022.They were divided into ART group(64 cases)and natural pregnancy group(136 cases)based on different conception methods,and the basic characteristics,the incidence of pregnancy complications,and neonatal outcomes were compared between the two groups.According to the different body mass index(BMI)of pregnant women during the establishment of the neck transparent layer(NT)examination,the study subjects were further stratified into normal weight(BMI 18.5-24.9 kg/m 2),overweight(BMI 25.0-27.9 kg/m 2),and obesity(BMI≥28.0 kg/m 2)groups.The incidence of pregnancy complications was compared between the normal weight group and the overweight obesity group.Results:Except for patients in the ART group who were significantly older than those in the natural pregnancy group(P<0.05),there were no significant differences in terms of the number of pregnancy,the proportion of primiparous women,and BMI between the two groups(P>0.05).The incidences of hypertensive disorder complicating pregnancy(46.88%vs.28.68%)and gestational diabetes mellitus(42.19%vs.22.79%)in ART group were significantly higher than those in natural pregnancy group(P<0.05).There were no significant differences in the incidence of premature birth,anemia,postpartum hemorrhage,placenta previa,etc.between the two groups(P>0.05).There were no significant differences in birth weight and the incidences of adverse neonatal outcomes such as low birth weigh and ischemic hypoxic encephalopathy between the ART group and the natural pregnancy group(P>0.05).In ART group,the incidences of hypertensive disorder complicating pregnancy(58.97%vs.28.00%)and gestational diabetes mellitus(56.41%vs.20.00%)in the overweight obesity group were significantly higher than those in the normal weight group(P<0.05).In the natural pregnancy group,the incidences of hypertensive disorder complicating pregnancy(37.50%vs.18.75%)and gestational diabetes mellitus(31.94%vs.12.50%)and premature delivery rate(16.67%vs.1.56%)in the overweight obesity group were significantly higher than those in the normal weight group(P<0.05).The incidences of hypertensive disorder complicating pregnancy(58.97%vs.37.50%)and gestational diabetes mellitus(56.41%vs.31.94%)in the overweight obesity group of the ART group were significantly higher than those in the overweight obesity group of the natural pregnancy group(P<0.05).Conclusions:The incidences of hypertensive disorder complicating pregnancy and gestational diabetes mellitus in women with dichorionic twins conceived by ART were significantly higher than those of the women with spontaneous dichorionic twins,but the influence of age could not be excluded.Whether dichorionic twins conceived by ART or spontaneous dichorionic twins,overweight or obesity was associated with an increased risk of pregnancy complications.
作者
武茜
余朝艳
温海秀
WU Qian;YU Chao-yan;WEN Hai-xiu(Obstetrics Department of Shanxi Fenyang Hospital/Shanxi Medical University Affiliated Fenyang Hospital,Fenyang 032200;Statistics Teaching and Research Department of Fenyang College,Shanxi Medical University,Fenyang 032200)
出处
《生殖医学杂志》
CAS
2024年第11期1437-1442,共6页
Journal of Reproductive Medicine
基金
吕梁市重点研发项目(2020SHFZ68)。
