北京市多胎妊娠流行现状与子代不良结局影响因素研究  

Prevalence of Multiple Gestation and Influencing Factors of Adverse Outcomes in Offspring in Beijing.

作　　者：张璐[1] 杨惠娟[1] 刘凯波[1] ZHANG Lu;YANG Huijuan;LIU Kaibo(Beijing Obstetrics and Gynecology Hospital,Capital Medical University/Beijing Maternal and Child Health Care Hospital,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院、北京妇幼保健院,100026

出　　处：《医学研究杂志》2023年第3期108-112,107,共6页Journal of Medical Research

基　　金：首都卫生发展科研专项(2018-2-2111)。

摘　　要：目的研究北京市多胎妊娠流行现状及子代不良结局的影响因素,探讨降低多胎妊娠发生和子代不良结局的方法与策略。方法回顾性纳入2020年1月1日~12月31日北京市妇幼信息系统中有明确妊娠结局的172237例孕妇及其子代,描述性分析自然受孕和辅助生殖技术受孕孕妇的多胎妊娠发生率和子代多胎出生率,比较多胎妊娠和单胎妊娠子代结局的差异,二元Logistic回归模型对多胎妊娠不良结局发生的影响因素进行多因素分析。结果2020年北京市孕妇多胎妊娠发生率为1.8%,子代多胎出生率为3.2%;其中辅助生殖技术受孕孕妇的多胎妊娠率为20.2%,多胎出生率为29.7%。多胎妊娠孕妇流产(12.0%vs 8.2%,OR=1.735,95%CI:1.592~1.890)、子代围生期死亡(4.9‰vs 2.7‰,OR=1.710,95%CI:1.112~2.629)和出生缺陷(7.7%vs 4.9%,OR=1.511,95%CI:1.351~1.690)的发生风险均高于单胎妊娠。结论2020年北京市孕妇多胎妊娠发生率较前增长,子代多胎出生率无明显上升。多胎妊娠孕妇流产、子代围生期死亡和出生缺陷的风险是单胎妊娠的1.5~1.7倍。持续推进辅助生殖技术“限制/减少胚胎移植数目”尤其是选择性单胚胎移植策略是进一步降低多胎妊娠发生并减少子代不良结局的主要推荐措施之一。Objective To study the prevalence of multiple gestations in Beijing and the influencing factors of adverse outcomes in the offspring,and to explore the methods and strategies to reduce the occurrence of multiple pregnancies and adverse outcomes in the offspring.Methods A total of 172237 pregnant women who underwent ultrasound screening in first-trimester and recorded pregnancy outcomes in Beijing from January 1,2020 to December 31,2020 and all their offspring are retrospectively included.Descriptive analysis of the occurrence of multiple gestations and offspring outcomes in natural pregnancies and assisted reproductive technology(ART)pregnancies were conducted to compare the differences in offspring outcomes of multiples and single pregnancy under different modes of conception.Binary Logistic regression models are used to analyze the multivariate risk of adverse offspring outcomes caused by multiple gestations.Results In 2020,the incidence of multiple pregnancy was 1.8%in Beijing,and the multiple births rate was 3.2%.Among them,the multiple pregnancy rate was 20.2%and the multiple births rate was 29.7%in ART pregnancies.The risk of miscarriage(12.0%vs 8.2%,OR=1.735,95%CI:1.592-1.890),perinatal death(4.9‰vs 2.7‰,OR=1.710,95%CI:1.112-2.629)and birth defects(7.7%vs 4.9%,OR=1.511,95%CI:1.351-1.690)in multiple pregnancy were higher than those of single pregnancy offspring.Conclusion In 2020,the incidence of multiple pregnancies among pregnant women in Beijing increased,but the multiple birth rate was relatively unchanged.The risk of miscarriage,perinatal death,and birth defects in the offspring of multiple pregnancy is approximately 1.5-1.7 times that of a single pregnancy.The strategy of″limiting/reducing the number of embryo transfers″in ART procedures especially the single-embryo transfer is one of the main recommended measures to further reduce the occurrence of multiple pregnancies and reduce adverse outcomes in the offspring.

关 键 词：多胎妊娠 流产 围生期死亡 出生缺陷 辅助生殖技术 

分 类 号：R71[医药卫生—妇产科学]