Impact of assisted reproductive technology on birth weight discordance in twins
LI Qiu-Ying, ZHANG Hui, CHEN Qian, SHI Bi-Jun, TAN Xiao-Hua, CUI Qi-Liang
Author information+
Department of Neonatology, Third Affiliated Hospital of Guangzhou Medical University/Guangzhou Key Laboratory of Neonatal Intestinal Diseases, Guangzhou 510150, China (Zhang H, Email: zhanghuigz@126.com)
Show less
文章历史+
收稿日期
出版日期
2023-07-12
2023-12-19
发布日期
2023-12-20
摘要
目的 探讨辅助生殖技术与双胎出生体重不一致(birth weight discordance in twins, BWDT)之间的关联。 方法 回顾性纳入2011年1月—2020年12月在广州医科大学附属第三医院出生且有完整的基本出生资料的双胎儿,采用多因素logistic回归分析探讨辅助生殖技术对BWDT发生的影响。 结果 共纳入3 974对双胎儿,其中自然受孕组1 431对,辅助生殖组2 543对。辅助生殖组新生儿出生体重大于自然受孕组(P<0.001);辅助生殖组BWDT发生率低于自然受孕组(16.17% vs 21.09%,P<0.001)。多因素logistic回归分析(校正了母亲年龄、孕次、孕前体重指数、妊娠糖尿病、甲状腺功能减退、胎龄及绒毛膜性质等混杂因素)显示,在辅助生殖组和自然受孕组之间,双胎出生体重不一致的发生风险差异无统计学意义(P>0.05)。 结论 辅助生殖技术与BWDT的发生风险无明显关联。
Abstract
Objective To explore the association between assisted reproductive technology (ART) and birth weight discordance in twins (BWDT). Methods A retrospective analysis was conducted on twin infants born between January 2011 and December 2020 at the Third Affiliated Hospital of Guangzhou Medical University, with complete basic birth data. The impact of ART on the occurrence of BWDT was identified by the multivariate logistic regression analysis. Results A total of 3 974 pairs of twins were included, with 1 431 conceived naturally and 2 543 through ART. Neonates in the ART group had higher birth weights than those in the naturally conceived group (P<0.001). The incidence of BWDT was lower in the ART group compared to the naturally conceived group (16.17% vs 21.09%, P<0.001). The multivariate logistic regression analysis, adjusting for confounding factors such as maternal age, parity, pre-pregnancy body mass index, gestational diabetes, hypothyroidism, gestational age, and chorionic properties, showed no significant difference in the risk of BWDT between the ART and naturally conceived groups (P>0.05). Conclusions ART is not associated with the risk of BWDT.
LI Qiu-Ying, ZHANG Hui, CHEN Qian, SHI Bi-Jun, TAN Xiao-Hua, CUI Qi-Liang.
Impact of assisted reproductive technology on birth weight discordance in twins[J]. Chinese Journal of Contemporary Pediatrics. 2023, 25(12): 1239-1245 https://doi.org/10.7499/j.issn.1008-8830.2307034
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 Saccone G, Khalil A, Thilaganathan B, et al. Weight discordance and perinatal mortality in monoamniotic twin pregnancy: analysis of MONOMONO, NorSTAMP and STORK multiple-pregnancy cohorts[J]. Ultrasound Obstet Gynecol, 2020, 55(3): 332-338. PMID: 31132179. DOI: 10.1002/uog.20357. 2 万燕南. 双胎生长不一致的成因与结局研究进展[J]. 现代医药卫生, 2019, 35(19): 2999-3002. DOI: 10.3969/j.issn.1009-5519.2019.19.019. 3 石碧君, 崔其亮, 谭小华, 等. 活产双胎出生体重不一致的发生情况及其与不良出生结局的关系[J]. 中华儿科杂志, 2022, 60(10): 1038-1044. PMID: 36207851. DOI: 10.3760/cma.j.cn112140-20220507-00432. 4 Miller J, Chauhan SP, Abuhamad AZ. Discordant twins: diagnosis, evaluation and management[J]. Am J Obstet Gynecol, 2012, 206(1): 10-20. PMID: 21864822. DOI: 10.1016/j.ajog.2011.06.075. 5 李慧玲, 张巍, 王萍. 双胎体重差异与新生儿疾病[J]. 中华临床医师杂志(电子版), 2013(14): 6317-6321. DOI: 10.3969/cma.j.issn.1674-0785.2013.14.026. 6 Hiersch L, Barrett J, Aviram A, et al. Patterns of discordant growth and adverse neonatal outcomes in twins[J]. Am J Obstet Gynecol, 2021, 225(2): 187.e1-187.e14. PMID: 33508311. DOI: 10.1016/j.ajog.2021.01.018. 7 Ben-Ami I, Sheena L, Svirsky R, et al. The association of crown-rump length discrepancy with birthweight discordance in spontaneous versus assisted conception dichorionic twins[J]. Prenat Diagn, 2014, 34(8): 748-752. PMID: 24633633. DOI: 10.1002/pd.4359. 8 钱蓓倩, 齐嫣婷, 张成强, 等. 双胎妊娠新生儿1 048例围生期临床情况分析[J]. 上海医学, 2017, 40(10): 598-602. 9 谢幸, 孔北华, 段涛. 妇产科学[M]. 9版. 北京: 人民卫生出版社, 2018: 83-92, 105-110, 127-129, 154-155, 123-124. 10 王卫平, 孙锟, 常立文. 儿科学[M]. 9版. 北京: 人民卫生出版社, 2018: 86. 11 姚菲, 缪华章, 祝新红, 等. 广东省双胎新生儿胎龄别出生体重百分位数曲线研究[J]. 中国生育健康杂志, 2018, 29(2): 126-133. DOI: 10.3969/j.issn.1671-878X.2018.02.005. 12 刘喜红. 高危儿的营养支持与健康管理[J]. 中国儿童保健杂志, 2022, 30(2): 120-123. DOI: 10.11852/zgetbjzz2022-0058. 13 中华医学会儿科学分会新生儿学组. 新生儿低血糖临床规范管理专家共识(2021)[J]. 中国当代儿科杂志, 2022, 24(1): 1-13. PMID: 35177170. PMCID: PMC8802387. DOI: 10.7499/j.issn.1008-8830.2108061. 14 中国妇幼保健协会新生儿保健专业委员会, 中国医师协会新生儿科医师分会. 母婴同室早发感染高危新生儿临床管理专家共识[J]. 中华围产医学杂志, 2021, 24(8): 567-575. DOI: 10.3760/cma.j.cn113903-20210310-00202. 15 中国妇幼保健协会新生儿保健专业委员会, 中国医师协会新生儿科医师分会. 产科母婴同室新生儿管理建议[J]. 中华新生儿科杂志, 2017, 32(2): 81-85. DOI: 10.3760/cma.j.issn.2096-2932.2017.02.001. 16 Young BC, Wylie BJ. Effects of twin gestation on maternal morbidity[J]. Semin Perinatol, 2012, 36(3): 162-168. PMID: 22713496. DOI: 10.1053/j.semperi.2012.02.007. 17 Qin JB, Wang H, Sheng X, et al. Assisted reproductive technology and risk of adverse obstetric outcomes in dichorionic twin pregnancies: a systematic review and meta-analysis[J]. Fertil Steril, 2016, 105(5): 1180-1192. PMID: 26801066. DOI: 10.1016/j.fertnstert.2015.12.131. 18 宋霁, 王雅琦, 沈豪飞, 等. 辅助生殖技术助孕后双胎生长不一致及其相关因素分析[J]. 生殖医学杂志, 2022, 31(9): 1232-1236. DOI: 10.3969/j.issn.1004-3845.2022.09.013. 19 Esposito G, Cantarutti A, Mauri PA, et al. Prevalence and factors associated with intertwin birth weight discordance among same-sex twins in Lombardy, Northern Italy[J]. Twin Res Hum Genet, 2023, 26(2): 177-183. PMID: 37189213. DOI: 10.1017/thg.2023.17. 20 张莉英, 余艳红, 陈惠英, 等. IVF-ET受孕双胎与自然受孕双胎的妊娠结局比较[J]. 中国妇幼保健, 2008, 23(9): 1286-1289. DOI: 10.3969/j.issn.1001-4411.2008.09.059. 21 曹娟, 蒙晶. 不同妊娠方式所致双胎母婴并发症的临床分析[J]. 中国儿童保健杂志, 2015, 23(5): 526-529. DOI: 10.11852/zgetbjzz2015-23-05-25. 22 陈小慧, 朱金改, 余章斌, 等. 辅助生殖技术双胎妊娠对新生儿结局的影响[J]. 中国当代儿科杂志, 2021, 23(1): 37-42. PMID: 33476535. PMCID: PMC7818157. DOI: 10.7499/j.issn.1008-8830.2009021. 23 Wang AY, Safi N, Ali F, et al. Neonatal outcomes among twins following assisted reproductive technology: an Australian population-based retrospective cohort study[J]. BMC Pregnancy Childbirth, 2018, 18(1): 320. PMID: 30089454. PMCID: PMC6083522. DOI: 10.1186/s12884-018-1949-0. 24 Wang YA, Nikravan R, Smith HC, et al. Higher prevalence of gestational diabetes mellitus following assisted reproduction technology treatment[J]. Hum Reprod, 2013, 28(9): 2554-2561. PMID: 23814097. DOI: 10.1093/humrep/det270. 25 Poppe K, Bisschop P, Fugazzola L, et al. 2021 European Thyroid Association guideline on thyroid disorders prior to and during assisted reproduction[J]. Eur Thyroid J, 2021, 9(6): 281-295. PMID: 33718252. PMCID: PMC7923920. DOI: 10.1159/000512790. 26 Broughton DE, Moley KH. Obesity and female infertility: potential mediators of obesity's impact[J]. Fertil Steril, 2017, 107(4): 840-847. PMID: 28292619. DOI: 10.1016/j.fertnstert.2017.01.017. 27 Kasum M, Ore?kovi? S, ?ehi? E, et al. The role of female obesity on in vitro fertilization outcomes[J]. Gynecol Endocrinol, 2018, 34(3): 184-188. PMID: 29037105. DOI: 10.1080/09513590.2017.1391209. 28 Sim?es T, Queirós A, Marujo AT, et al. Outcome of monochorionic twins conceived by assisted reproduction[J]. Fertil Steril, 2015, 104(3): 629-632. PMID: 26093266. DOI: 10.1016/j.fertnstert.2015.06.002. 29 Mascarenhas M, Kamath MS, Muthukumar K, et al. Obstetric outcomes of monochorionic pregnancies conceived following assisted reproductive technology: a retrospective study[J]. J Hum Reprod Sci, 2014, 7(2): 119-124. PMID: 25191025. PMCID: PMC4150138. DOI: 10.4103/0974-1208.138870. 30 侯林, 朱巍巍, 张慧, 等. 双胎新生儿结局及绒毛膜性和受孕方式对其的影响[J]. 中华围产医学杂志, 2019, 22(12): 849-858. DOI: 10.3760/cma.j.issn.1007-9408.2019.12.004. 31 张丽, 董彦会, 马军. 新生儿双胎体重不均衡的现状及其危险因素分析[J]. 中国新生儿科杂志, 2016, 31(6): 438-441. DOI: 10.3969/j.issn.1673-6710.2016.06.009. 32 程曦, 肖辉云, 邹兴文, 等. 不同受孕方式双胎妊娠围产期并发症的差异分析[J]. 现代妇产科进展, 2020, 29(1): 33-35. DOI: 10.13283/j.cnki.xdfckjz.2020.01.007. 33 张懿敏, 张晓蕊, 刘捷, 等. 双胎发育不一致的独立危险因素及新生儿期合并症的临床研究[J]. 中华实用儿科临床杂志, 2019, 34(8): 614-617. DOI: 10.3760/cma.j.issn.2095-428X.2019.08.013. 34 胡淑君, 孙红, 邓宇, 等. 双绒毛膜双胎胎盘血管结构与胎儿体重的关系[J]. 中国生育健康杂志, 2011, 22(2): 80-82. DOI: 10.3969/j.issn.1671-878X.2011.02.005. 35 李洋洋, 张志涛, 刘彩霞, 等. 《双胎门诊分级指南》团体标准的制定与实践[J]. 中国实用妇科与产科杂志, 2021, 37(11): 1170-1172. DOI: 10.19538/j.fk2021110120. 36 Homola W, Florjański J, Królak-Olejnik B, et al. The impact of chorionicity and the type of twin growth on the early neonatal outcome in twin pregnancies: 20 years of experience from one tertiary perinatal center[J]. Taiwan J Obstet Gynecol, 2019, 58(4): 482-486. PMID: 31307737. DOI: 10.1016/j.tjog.2019.05.009. 37 De Paepe ME, Shapiro S, Young L, et al. Placental characteristics of selective birth weight discordance in diamniotic-monochorionic twin gestations[J]. Placenta, 2010, 31(5): 380-386. PMID: 20303588. DOI: 10.1016/j.placenta.2010.02.018. 38 Breathnach FM, McAuliffe FM, Geary M, et al. Definition of intertwin birth weight discordance[J]. Obstet Gynecol, 2011, 118(1): 94-103. DOI: 10.1097/AOG.0b013e31821fd208. PMID: 21691168.