双胞胎怀孕不良结果的危险因素:叙述性审查
Maya Whittaker1,2, Isabelle Greatholder2, Mark D Kilby3,4,5
1Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
概括
双胞胎和单胎怀孕之间的不良妊娠结果的危险因素不同. 双胞胎的单性和晚年母亲的年龄增加了双胞胎的风险,而一些因素,如ART使用似乎有保护作用.
科学领域:
- 产科和妇科 产科和妇科
- 围产儿医学 围产儿医学
- 生殖健康 生殖健康
背景情况:
- 全球双胞胎怀孕正在增加,原因是辅助生殖技术 (ART),延迟生育和移民.
- 双胞胎怀孕与单独怀孕相比,对不良结果的绝对风险更高.
- 关于风险因素的现有数据通常从单个人群中推断出来,需要针对双胞胎怀孕的有针对性的证据.
研究的目的:
- 综合审查各种风险因素与不良结果之间的关联,特别是在双胞胎怀孕中.
- 为了将这些关联与单独怀孕中观察到的关联进行比较.
- 确定需要针对双胞胎怀孕改善产前护理的定制指导的因素.
主要方法:
- 系统性审查检查了风险因素,包括胆管性,晚年母亲年龄 (AMA),体重指数 (BMI),社会经济和种族因素,吸烟,ART,胎儿运动感知和并发性疾病 (妊娠高血压障碍[HDP],妊娠糖尿病[GDM]).
- 分析的不良结果包括早产,新生儿重症监护室 (NICU) 入院,死产和新生儿死亡率.
- 研究承认早期胎儿损失 (22-24周之前) 的代表性不足.
主要成果:
- 单性与死产,新生儿重症监护室入院和双胞胎怀孕中早产的风险增加有关.
- 晚期孕产妇年龄 (AMA) 增加了双胞胎死亡,新生儿重症监护室入院和早产的风险,与单生双胞胎相比.
- 像BMI,社会经济不平等,吸烟,ART和HDP这样的因素对双胞胎怀孕的不良结果的影响相对较小,可能是由于基线风险更高. ART和GDM可以提供对双胞胎围产死亡率的保护作用.
结论:
- 双胞胎和单独怀孕之间的不良妊娠结果的风险因素概况显著不同.
- 进一步的研究至关重要,以完善对双胞胎怀孕中的风险因素关联的理解.
- 针对双胞胎怀孕需要量身定制的指导和改进的产前护理策略,具体证据提供信息.
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