目的:探讨妊娠期不适当增重(GWG)对体外受精(IVF)双胎孕妇妊娠结局的影响。
方法:这项回顾性队列研究包括2992名双胎孕妇,并将参与者分类如下:(i)根据他们是否接受IVF治疗将他们分为自发受孕(SC)或IVF组。和(ii)它们被归类为不充分,最优,或根据国际移民组织双胎妊娠指南过度GWG组。最初,本研究调查了IVF治疗和不同水平GWG对双胎妊娠结局的影响.随后,在对混杂因素进行调整后,我们进行了多因素logistic回归分析,以进一步研究IVF治疗和高GWG对双胎妊娠结局的影响.基于此,根据是否使用IVF进行分层分析,以探讨不同GWG水平对每个亚组(接受IVF的患者和自发受孕的患者)的影响.最后,我们检查了IVF和不同GWG类别之间潜在的乘法相互作用,以确定它们对妊娠结局的综合影响.
结果:结果显示,通过IVF受孕的双胎妇女的母亲年龄明显更高,孕前体重指数,与SC组相比,超出推荐指南的GWG发生率更高。此外,IVF治疗和不适当的GWG都会增加不良妊娠结局的风险,分别。在通过多因素逻辑回归对混杂变量进行调整后,研究表明,IVF治疗和高GWG治疗均显着提高了双胎妊娠不良结局的风险,例如进入新生儿重症监护室。值得注意的是,不合适的GWG,结合IVF治疗,会逐步增加妊娠期肝内胆汁淤积症的发病率,呼吸衰竭,呼吸窘迫,先兆子痫,孕产妇重症监护病房入院,和产后出血的风险。然而,在SC组中,不适当的GWG对这些结局的影响较小.最后,本研究未揭示IVF手术和不同GWG水平与不良结局之间的显著交互作用.
结论:在IVF治疗的双胎妊娠中,不适当GWG的发生率较高,与SC组相比,IVF组的不适当GWG导致更多的不良双胎妊娠结局。这项研究表明,适当管理GWG可能是减少与IVF相关的双胎妊娠不良结局的突破。因此,实施积极的干预措施,如监督锻炼计划,规定的身体或饮食计划,加强体重管理,或个性化咨询,有望降低IVF导致的双胎妊娠中与不适当GWG相关的风险。
OBJECTIVE: To investigate the influence of inappropriate gestational weight gain (GWG) on pregnancy outcomes in twin pregnant women with in vitro fertilization (IVF) treatment.
METHODS: This retrospective cohort study included 2992 twin pregnant women and categorized the participants as follows: (i) they were classified into spontaneous conception (SC) or IVF groups based on whether they received IVF treatment, and (ii) they were categorized into inadequate, optimal, or excessive GWG groups according to the International Organization for Migration Twin Pregnancy Guidelines. Initially, the study investigated the separate effects of IVF treatment and different levels of GWG on the outcomes of twin pregnancies. Subsequently, after adjusting for confounding factors, multifactorial logistic regression analysis was performed to further investigate the impact of IVF treatment and high GWG on twin pregnancy outcomes. Based on this, the analysis was stratified by whether IVF was used to explore the effects of different GWG levels on each subgroup (those who underwent IVF and those who conceived spontaneously). Finally, potential multiplicative interactions between IVF and different GWG categories were examined to identify their combined effect on pregnancy outcomes.
RESULTS: The results showed that women with twin gestations conceived via IVF exhibited significantly higher maternal age, pre-pregnancy body mass index, and a greater incidence of GWG beyond recommended guidelines compared to the SC group. Furthermore, both IVF treatment and inappropriate GWG increased the risk of adverse pregnancy outcomes, respectively. Following adjustments for confounding variables through multifactorial logistic regression, it was demonstrated that both IVF treatment and high GWG significantly elevated the risk of adverse outcomes in twin pregnancies, such as admission to the neonatal intensive care unit. It is noteworthy that inappropriate GWG, combined with IVF treatment, will stepwise increase the incidence of intrahepatic cholestasis of pregnancy, respiratory failure, respiratory distress, pre-eclampsia, maternal intensive care unit admission, and postpartum hemorrhage risk. However, these outcomes were less affected by inappropriate GWG in the SC group. Lastly, this study did not unveil a significant interaction between the IVF procedure and disparate levels of GWG in relation to the adverse outcomes.
CONCLUSIONS: A high incidence of inappropriate GWG in twin pregnancies with IVF treatment and inappropriate GWG conferred more adverse twin pregnancy outcomes in the IVF group relative to the SC group. This study indicates that proper management of GWG may be a breakthrough in reducing adverse outcomes in twin pregnancies associated with IVF. Therefore, implementing proactive interventions such as supervised exercise programs, prescribed physical or dietary plans, enhanced weight management, or personalized counseling, holds promise for lowering the risks associated with inappropriate GWG in twin pregnancies resulting from IVF.