试管婴儿需求如何影响多胎妊娠的妊娠并发症?对包括近 10 万名多胎妊娠者在内的大型美国人口数据库进行的研究

IF 1.5 Q3 OBSTETRICS & GYNECOLOGY
Samar Mandourah , Ahmad Badeghiesh , Haitham Baghlaf , Michael H. Dahan
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引用次数: 0

摘要

研究目的本研究旨在比较自然受孕与体外受精(IVF)的多胎妊娠结局。研究设计这是一项回顾性队列研究,使用的是医疗成本与利用项目-全国住院患者样本(HCUP-NIS)数据库。我们的研究队列包括 2008 年至 2014 年期间自然受孕的 90,552 例多胎妊娠和 3219 例试管婴儿受孕。在对混杂变量进行调整的同时,对产妇和新生儿的结局进行了多变量逻辑回归分析比较。研究对象使用ICD-9多胎妊娠编码:651.X和76.1,以及IVF的ICD-9编码:23.85。结果和结论IVF多胎妊娠发生妊娠诱发高血压(aOR 1.31,95 % CI 1.20-1.43)、妊娠高血压(aOR 1.21,95 % CI 1.04-1.41)、子痫前期(aOR 1.31,95 % CI 1.19-1.45)、妊娠糖尿病(aOR 1.26,95 % CI 1.13-1.41)和前置胎盘(aOR 1.7,95 % CI 1.32-2.19)。试管婴儿的分娩结果更有可能因剖腹产(aOR 1.21,95 % CI 1.10-1.33)、早产胎膜早破(aOR 1.33,95 % CI 1.绒毛膜羊膜炎(aOR 1.71,95 % CI 1.37-2.14)、产后出血(aOR 1.44,95 % CI 1.26-1.63)和输血(aOR 1.48,95 %CI 1.26-1.74)。试管婴儿的新生儿结局更可能因胎龄小(aOR 1.26,95 % CI 1.12-1.41)和先天性畸形(aOR 1.82,95 % CI 1.29-2.57)而复杂化。在多胎妊娠中,试管婴儿增加了妊娠、分娩和新生儿结局的风险,风险从 20% 增加到 70%。应进一步评估不孕症对试管婴儿需求的影响以及试管婴儿方案的类型。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
How does the need for IVF affect pregnancy complications among multiple gestations? The study of a large American population database including almost 100,000 multiple gestations

Objective

This study’s aim is to compare pregnancy outcomes in multifetal gestations that were conceived spontaneously compared to in vitro fertilization (IVF). Few population-based studies have addressed this topic.

Study design

This is a retrospective cohort study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database. Our study cohort included 90,552 multifetal gestations conceived spontaneously and 3219 IVF conceptions, from 2008 to 2014, inclusively. Multivariate logistic regression analyses were performed comparing maternal and neonatal outcomes, whilst adjusting for confounding variables. Subject was conducted using ICD-9 codes for multifetal gestation: 651. X and 76.1 and ICD-9 code for IVF: 23.85. Each pregnancy was included once.

Results and conclusion

IVF multifetal gestations had increased risk of pregnancy-induced hypertension (aOR 1.31, 95 % CI 1.20–1.43), gestational hypertension (aOR 1.21, 95 % CI 1.04–1.41), preeclampsia (aOR 1.31, 95 % CI 1.19–1.45), gestational diabetes (aOR 1.26, 95 % CI 1.13–1.41) and placenta previa (aOR 1.7, 95 % CI 1.32–2.19). IVF delivery outcomes were more likely complicated by cesarean section (aOR 1.21, 95 % CI 1.10–1.33), preterm premature rupture of membranes (aOR 1.33, 95 % CI 1.16–1.52), chorioamnionitis (aOR 1.71, 95 % CI 1.37–2.14), postpartum hemorrhage (aOR 1.44, 95 % CI 1.26–1.63) and transfusions (aOR 1.48, 95 %CI 1.26–1.74). IVF neonatal outcomes were more likely complicated by small for gestational age (aOR 1.26, 95 % CI 1.12–1.41) and congenital anomalies (aOR 1.82, 95 % CI 1.29–2.57). IVF was not found to increase risks of eclampsia, preterm delivery, operative vaginal delivery, hysterectomy, or intrauterine fetal demise.

IVF increased the risk of pregnancy, delivery, and neonatal outcomes in multifetal pregnancies with risks increased from 20 % to 70 %. The role of infertility versus the need for IVF and the type of IVF protocol used should be further evaluated.

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