Is There a Cumulative Effect for Congenital Heart Defects in Monochorionic Twins after Assisted Reproduction? - A Retrospective Analysis at a Tertiary Referral Center.

IF 2.4 4区医学 Q2 OBSTETRICS & GYNECOLOGY Geburtshilfe Und Frauenheilkunde Pub Date : 2024-03-06 eCollection Date: 2024-03-01 DOI:10.1055/a-2238-3181

Jarmila A Zdanowicz, Gülay Yildrim, Andreia Fonseca, Kurt Hecher, Manuela Tavares de Sousa

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Abstract

Introduction: The aim of our study was to compare maternal, chorionicity and neonatal complications in monochorionic (MC) twins between spontaneously conceived (SC) and assisted reproductive technologies (ART) pregnancies.

Material and methods: This was a retrospective cohort study between January 2010 to December 2019 at a tertiary referral University center. All consecutive pregnancies with MC twins that delivered at our University hospital were included. Maternal, chorionicity and neonatal complications were recorded and compared between SC and ART pregnancies.

Results: 393 MC pregnancies were included for final analysis, including 353 (89.8%) SC and 40 (10.2%) pregnancies conceived after ART. Hypothyroidism was the only maternal condition seen significantly more often in ART pregnancies (35.0% vs 12.5%, p = 0.001). There were no significant differences in chorionicity complications, such as twin-twin transfusion syndrome, selective fetal growth restriction and twin anemia-polycythemia sequence (40.0% in ART pregnancies vs 31.6% in SC pregnancies, p = 0.291). At least one congenital anomaly in one twin was seen significantly more often in ART pregnancies (18.8% vs 8.1%, p = 0.004), especially congenital heart defects (16.3% vs 6.2%, p = 0.005). There were no other significant differences in neonatal outcomes between both groups, however, there were non-significant trends in gestational age at delivery (34 weeks in ART pregnancies vs 35 weeks, p = 0.078) and birthweight (1951 g ± 747 in ART pregnancies vs 2143 g ± 579, p = 0.066).

Conclusion: This is the largest cohort study to date comparing maternal, chorionicity and neonatal complications between MC twin pregnancies after ART and after SC. Hypothyroidism was the only maternal condition occurring more frequently in pregnancies conceived after ART. There were no significant differences in chorionicity complications, in contrast to previously reported studies. While MC twins and ART pregnancies per se are known to be at risk for congenital heart defects, there seems to be a cumulative effect in MC pregnancies conceived after ART.

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辅助生殖后的单绒毛膜双胎先天性心脏缺陷有累积效应吗？- 一家三级转诊中心的回顾性分析。

导言：我们的研究旨在比较自然受孕（SC）和辅助生殖技术（ART）妊娠的单绒毛膜双胎（MC）的母体、绒毛膜性和新生儿并发症：这是一项回顾性队列研究，研究时间为 2010 年 1 月至 2019 年 12 月，研究地点在一所大学的三级转诊中心。所有在本大学医院分娩的 MC 双胞胎孕妇均被纳入研究范围。记录母体、绒毛膜性和新生儿并发症，并对SC和ART妊娠进行比较：最终分析共纳入 393 例 MC 胎，其中包括 353 例（89.8%）SC 胎和 40 例（10.2%）经 ART 受孕的胎儿。甲状腺功能减退症是唯一一种在 ART 妊娠中出现频率明显较高的母体疾病（35.0% vs 12.5%，P = 0.001）。绒毛膜性并发症，如双胎输血综合征、选择性胎儿生长受限和双胎贫血多血症序列（ART 妊娠为 40.0%，SC 妊娠为 31.6%，P = 0.291）没有明显差异。ART 妊娠中至少有一个双胎出现先天性异常的比例明显更高（18.8% vs 8.1%，p = 0.004），尤其是先天性心脏缺陷（16.3% vs 6.2%，p = 0.005）。两组之间的新生儿结局没有其他明显差异，但在分娩时胎龄（ART 怀孕 34 周 vs 35 周，p = 0.078）和出生体重（ART 怀孕 1951 g ± 747 vs 2143 g ± 579，p = 0.066）方面有不明显的趋势：这是迄今为止规模最大的队列研究，比较了ART和SC术后MC双胎妊娠的母体、绒毛膜和新生儿并发症。甲状腺功能减退症是 ART 后妊娠中唯一较常发生的母体疾病。在绒毛膜并发症方面没有明显差异，这与之前报道的研究不同。众所周知，MC 双胎和 ART 妊娠本身都有先天性心脏缺陷的风险，但在 ART 后受孕的 MC 妊娠中似乎存在累积效应。

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

Geburtshilfe Und Frauenheilkunde 医学-妇产科学

CiteScore

2.50

自引率

22.20%

发文量

828

审稿时长

6-12 weeks

期刊介绍： Geburtshilfe und Frauenheilkunde (GebFra) addresses the whole field of obstetrics and gynecology and is concerned with research as much as with clinical practice. In its scientific section, it publishes original articles, reviews and case reports in all fields of the discipline, namely gynecological oncology, including oncology of the breast obstetrics and perinatal medicine, reproductive medicine, and urogynecology. GebFra invites the submission of original articles and review articles. In addition, the journal publishes guidelines, statements and recommendations in cooperation with the DGGG, SGGG, OEGGG and the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF, Association of Scientific Medical Societies, www.awmf.org). Apart from the scientific section, Geburtshilfe und Frauenheilkunde has a news and views section that also includes discussions, book reviews and professional information. Letters to the editors are welcome. If a letter discusses an article that has been published in our journal, the corresponding author of the article will be informed and invited to comment on the letter. The comment will be published along with the letter.