冯春阳^1,,
薛玉杰²,
李冬^2,,
1. 大连医科大学 研究生院，辽宁 大连 116044
2. 大连市妇女儿童医疗中心（集团） 新生儿科，辽宁 大连 116037

详细信息 作者简介: 冯春阳（1997-），女，硕士研究生。E-mail：1135455466@qq.com



通讯作者: 李 冬，教授。E-mail：dongli_dmu@163.com 中图分类号: R722.6


摘要:目的分析辅助生殖技术受孕（assisted reproductive technology，ART）与自然受孕（natural conception， NC）双胎早产儿出生合并症及出院后体格发育远期结局。方法选取大连市妇女儿童医疗中心2019年1月至2020年12月出生并入住新生儿重症监护病房且出院后定期随访的双胎早产儿进行研究。根据受孕方式，将其分为ART组（168例）和NC组（54例），收集产母及新生儿的一般资料（包括产母年龄、妊娠期高血压、妊娠期糖尿病、绒毛膜羊膜炎、胎膜早破、分娩方式、胎儿性别、Apgar评分、是否存在生长差异等）、新生儿出生结局（新生儿窒息、新生儿低血糖症、呼吸窘迫综合征、新生儿坏死性小肠结肠炎、动脉导管未闭、颅内出血）以及纠正月龄（corrected age， CA）6个月、12个月时的身长、体重、头围数据。对其进行比较分析，并对早产儿呼吸支持进行危险因素分析。结果ART组产母年龄32.15（31.59，32.17）岁，与NC组产母年龄29.65（28.4，30.84）岁比较，差异具有统计学意义（P＜0.001），ART组产母妊娠期高血压、妊娠期糖尿病、胎膜早破以及绒毛膜羊膜炎发生率与NC组比较，差异无统计学意义（P＞0.05）。ART组早产儿出生胎龄、性别、出生方式、Apgar评分、双胎之间是否存在生长差异、喂养时间及呼吸支持情况与NC组比较，差异均无统计学意义（P＞0.05）。ART组新生儿出生合并症（新生儿窒息、极低出生体重儿、新生儿低血糖症、呼吸窘迫综合征、早发败血症、动脉导管未闭）、婴儿期体格生长指标（身长、体重、头围）与NC组比较，差异均无统计学意义（P＞0.05）。多因素二元logistic回归分析显示妊娠期糖尿病以及胎膜早破是早产儿出生后需要呼吸支持的独立危险因素（P＜0.05）。结论ART没有增加双胎早产儿出生的不良结局。妊娠期糖尿病及胎膜早破是早产儿呼吸支持的独立危险因素。
关键词: 辅助生殖技术/
双胎/
早产儿/
妊娠结局


Abstract:ObjectiveTo analyze the neonatal outcome and long-term development of assisted reproductive technology (ART) and natural conception (NC) in premature twins. MethodsPremature twins, who were born in Dalian Women and Children's Medical Center from January 2019 to December 2020, admitted to the neonatal intensive care unit (NICU) and regularly followed up after discharge, were included in the study. According to the way of conception, the infants were divided into ART group (168 cases) and NC group (54 cases). The general data of the mother and newborn, including maternal age, gestational hypertension, gestational diabetes, chorioamnionitis, premature rupture of membranes, mode of delivery, fetal sex, Apgar score, and presence of growth differences, were collected. Birth outcome and disease (neonatal asphyxia, respiratory distress syndrome, neonatal necrotizing small bowel colitis, patent ductus arteriosus, and intracranial hemorrhage) during hospitalization were analyzed. Outpatient follows up information including the length, weight, and head circumference data at the corrected age (CA) of 6 months and 12 months were summarized. We analyzed and compared the general conditions, birth comorbidities, and growth and development in infancy between the two groups. Risk factor for respiratory support in admission was also analyzed. ResultsThe maternal age in the ART group [32.15 (31.59, 32.17) years] was significantly different from that in the NC group [29.65 (28.45, 30.84) years] (P＜0.001). While the incidence of gestational hypertension, gestational diabetes, premature rupture of membranes and chorioamnionitis in the ART group was similar to that in the NC group (P＞0.05). There were no significant differences in gestational age at birth, gender, mode of birth, Apgar score, presence of growth difference between twins, duration of feeding, and respiratory support in the ART group compared with the NC group (P＞0.05). The differences in birth comorbidities (neonatal asphyxia, very low birth weight of the infant, neonatal hypoglycemia, respiratory distress syndrome, early onset sepsis, patent ductus arteriosus) were not statistically significant (P＞0.05). And there were no differences when comparing the physical growth indicators (length, weight, head circumference) during infancy between the ART and NC groups (P＞0.05). Gestational diabetes mellitus as well as premature rupture of membranes were the risk factors for preterm infants requiring respiratory support after birth (P＜0.05). ConclusionART doesn't increase the risk of adverse birth outcome for premature twins. Gestational diabetes mellitus and premature rupture of membranes are the independent risk factors for respiratory support in premature infants.
Keywords:assisted reproductive technology/
twins/
premature infant/
pregnancy outcome

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