Long-term gastrointestinal morbidity among twins conceived by assisted reproductive technology

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology Pub Date : 2025-05-05 DOI:10.1016/j.ejogrb.2025.114030

Amir Snir , Tamar Wainstock , Gil Gutvirtz , Eyal Sheiner

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引用次数: 0

Abstract

Background

Assisted reproductive technologies (ART) increased the incidence of multiple pregnancies, which has a negative effect on offspring health outcomes. The long-term health outcomes for singletons born after ART is well studied, however, studies on ART twin’s long-term morbidities are scarce.

Objective

This study aimed to investigate a possible association between ART resulting in twin pregnancy and long-term gastrointestinal (GI) morbidity of the offspring.

Study design

A population-based cohort study was performed in a tertiary medical center including twin deliveries born between 1991–2021. Long-term GI morbidities among twins conceived via ART including ovulation induction (OI) and in-vitro fertilization (IVF) were compared with twins born following spontaneous pregnancies. The diagnoses of GI morbidities were defined based on ICD-9 codes as recorded in community clinics and hospitalization files. A Kaplan–Meier survival curve was used to compare the cumulative incidence of GI morbidity among the study group and a Cox proportional hazards model was constructed to control for possible confounders.

Results

A total of 7,790 twins met the inclusion criteria: 2,076 twins (26.6 %) were conceived by ART. The total GI morbidity rate was significantly higher in twins conceived by ART as compared with twins from spontaneous pregnancies (34.9 % for IVF, 34.3 % for OI and 27.0 % for spontaneous twins, p < 0.001). In addition, the cumulative incidence of GI morbidity over time was elevated for twins conceived by ART (log-rank test, p < 0.001). The Cox model, controlling for confounders such as maternal age, gestational age, hypertensive disorders and diabetes mellitus found that using ART resulting in twin pregnancy is an independent risk factor for long-term GI morbidity of twin offspring (adjusted hazards ratio (aHR) for IVF vs. spontaneous = 1.42 (95 %CI 1.27–1.58, p < 0.001; aHR for OI vs spontaneous = 1.38 (95 %CI 1.20–1.60, p < 0.001).

Conclusion

In our cohort, twins conceived by ART exhibited a higher risk for long-term GI morbidity compared with spontaneously conceived twins. This association remained after adjustment for confounders although part of the increased risk may be mediated by perinatal complications such as prematurity and cesarean delivery.

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辅助生殖技术孕育的双胞胎的长期胃肠疾病

辅助生殖技术（ART）增加了多胎妊娠的发生率，这对后代的健康结果产生了负面影响。对抗逆转录病毒治疗后出生的单胎的长期健康结果进行了很好的研究，然而，对抗逆转录病毒治疗双胞胎的长期发病率的研究很少。目的探讨抗逆转录病毒治疗导致的双胎妊娠与后代长期胃肠道（GI）发病率之间的可能关系。研究设计在三级医疗中心进行了一项基于人群的队列研究，包括1991-2021年间出生的双胞胎。通过ART包括促排卵（OI）和体外受精（IVF）受孕的双胞胎与自然妊娠出生的双胞胎的长期GI发病率进行了比较。根据社区诊所和住院档案记录的ICD-9代码定义胃肠道疾病的诊断。Kaplan-Meier生存曲线用于比较研究组胃肠道发病率的累积，并构建Cox比例风险模型来控制可能的混杂因素。结果7790对双胞胎符合入选标准，其中ART受孕2076对，占26.6%。与自然妊娠双胞胎相比，ART妊娠双胞胎的胃肠道总发病率明显更高(IVF为34.9%，OI为34.3%，自然妊娠双胞胎为27.0%,p <；0.001)。此外，接受抗逆转录病毒技术（ART）受孕的双胞胎，随着时间的推移，胃肠道疾病的累积发病率升高(log-rank检验，p <；0.001)。Cox模型在控制了母亲年龄、胎龄、高血压疾病和糖尿病等混杂因素后发现，使用ART导致双胎妊娠是导致双胞胎后代长期GI发病率的独立危险因素(IVF与自然妊娠的校正危险比(aHR) = 1.42 (95% CI 1.27-1.58, p <；0.001;成骨不全与自发性的aHR = 1.38 (95% CI 1.20-1.60, p <；0.001)。结论在我们的队列中，与自然受孕的双胞胎相比，ART受孕的双胞胎长期胃肠道疾病的风险更高。在调整混杂因素后，这种关联仍然存在，尽管部分风险增加可能是由围产期并发症（如早产和剖宫产）介导的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European journal of obstetrics, gynecology, and reproductive biology 医学-妇产科学

CiteScore

4.60

自引率

3.80%

发文量

898

审稿时长

8.3 weeks

期刊介绍： The European Journal of Obstetrics & Gynecology and Reproductive Biology is the leading general clinical journal covering the continent. It publishes peer reviewed original research articles, as well as a wide range of news, book reviews, biographical, historical and educational articles and a lively correspondence section. Fields covered include obstetrics, prenatal diagnosis, maternal-fetal medicine, perinatology, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, sexual medicine and reproductive ethics. The European Journal of Obstetrics & Gynecology and Reproductive Biology provides a forum for scientific and clinical professional communication in obstetrics and gynecology throughout Europe and the world.