医疗辅助生殖产生的多胎儿:不同类型的手术的贡献以及随着时间的推移的趋势
Giovanna Esposito1, Fabio Parazzini1, Paola Viganò2
1Department of Clinical Sciences and Community Health, Dipartimento di Eccellenza 2023-2027, University of Milan, Milan, Italy.
概括
自2007年以来,医疗辅助生殖 (MAR) 策略,特别是体外受精 (IVF),已经显著减少了多胎产. 然而,与MAR相关的多胎仍然比自发怀孕高得多.
科学领域:
- 生殖医学 生殖医学
- 公共卫生 公共卫生
- 生物统计学 生物统计学
背景情况:
- 医疗辅助生殖 (MAR) 涵盖了克服不孕症的各种治疗方法.
- 多胎产,已知与MAR相关的风险,对母亲和孩子都有增加的风险.
- 了解不同MAR策略对多胎出生率的影响对于优化生殖结果至关重要.
研究的目的:
- 为了比较一线MAR治疗 (带有或没有宫内授精的卵巢刺激) 与体外受精 (IVF) 程序在减少多胎风险方面的有效性.
- 分析2007年至2022年间不同MAR技术的多胎出生率的时间趋势.
主要方法:
- 伦巴第地区 (2007-2022) 医疗保健利用数据库的回顾性分析.
- 包括所有由MAR产生的分娩,将它们分类为一线治疗和试管婴儿手术.
- 计算多胎发病率和应用线性回归来评估时间趋势,按母亲年龄分层.
主要成果:
- 总共分析了30900例MAR分娩,其中14.5%来自一线治疗,85.5%来自试管婴儿.
- 总体而言,多胎儿出生率从2007年的22.0%大幅下降到2022年的8.7% (p < 0.01).
- 从试管婴儿手术中产生的多胎儿明显下降 (23.8%至8.4%),而从一线治疗中产生的多胎儿保持稳定 (13.5%至12.0%).
结论:
- 试管婴儿策略和程序的变化是MAR后减少多胎产生的主要驱动因素.
- 试管婴儿后多胎儿的减少在2009年之后加速,与意大利的监管变化相吻合.
- 尽管出现了显著的减少,但MAR的多胎出生率仍然大约是自发怀孕的十倍.
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