| Objective:To compare the maternal and neonatal period clinical profiles of spontaneously-conceived and in vitro fertilization(IVF)twin premature pregnancies,and provide reference information for the clinical management of IVF twin premature infantsMethods:The retrospective analysis method was adopted.The twin premature infants who were born in the obstetrics department and transferred to neonatology department of the First Affiliated Hospital of Kunming Medical University from January 2017 to October 2019 was selected as the research object.IVF twin premature infants were the experimental group(IVF group),and the spontaneously-conceived twin preterm infants were the control group.The clinical data of the pregnant women and twin premature infants with in neonatal period in both of two groups were collected and compared,including pregnancy-related complications,condition of placenta,umbilical cord and amniotic fluid,disease status and the outcome of the neonatal period of the twins.SPSS 25.0 software was used for data processing and statistical analysis.The measurement data were expressed in terms of mean standard deviation(x ± s)or median(M),in which normal distribution data were tested by t test,while non-normal distribution data were tested by rank sum test.The enumeration data were expressed as a percentage(%),and the chi-square test was used for comparison between the two groups.P<0.05 represented statistically significant.Results:1.Comparison of the general situation of preterm infants between the IVF group and the control group.During the data collection period,18488 newborns were born in the First Affiliated Hospital of Kunming Medical University,and 2047 premature infants were born,the overall premature birth rate was 11.1%(2074/18488);There were 1355twins,including 737 twin premature infants,the rate of preterm birth in twins was 54.4%(737/1355);A total of 571 were IVF twin infants,among which 290 were IVF twin premature infants,the preterm delivery rate in IVF twins was 50.8%(290/571).The proportion of IVF twin preterm infants in total twin preterm infants was 39.3%(290/737).In this study,the average gestational age of IVF group was(34.14±2.15)weeks,average birth weight was(1923.64±416.73)g.Average gestational age of control group was(34.39±2.18)Weeks,average birth weight was(1936.77±495.83)g.There was no significant difference in the average gestational age and birth weight between the two groups(t value were 1.159 and 0.285,P value were 0.247 and 0.775).There were 113 male infants and 86 female infants in the IVF group,with a sex ratio of 1.31:1;In the control group,there were 91 male infants and 107 female infants,with a sex ratio of 0.85:1.There was significant difference in the sex ratio of male and female between the two groups(?2=4.655,P=0.031).2.Comparison of the prevalence of preterm infants between the IVF group and the control group.The incidence rate of neonatal hyperbilirubinemia in the IVF group was 68.8%(137/199),the control group was 59.1%(117/198);The incidence rate of transient hypothyroidism of prematurity(THOP)in the IVF group was 3.0%(6/199),the control group was0.0%(0/198);The incidence rate of atrial septal defect(ASD)in the IVF group was 28.6%(20/70),and the control group was 14.3%(10/70);The incidence rate of twin-twin transfusion syndrome(TTTS)in the IVF group was 0.0%(0/199),and the control group was 3.5%(7/198).There were significant differences in the incidence rate of neonatal hyperbilirubinemia,THOP,ASD and TTTS between the two groups(?2value were 4.097?4.205?4.242 and 5.266,P value were0.043?0.040?0.039 and 0.022,respectively).There was no significant difference in the incidence rate of neonatal respiratory distress syndrome,neonatal wet lung,bronchopulmonary dysplasia(BPD),feeding intolerance,neonatal necrotizing enterocolitis(NEC),infection,intracranial hemorrhage,neonatal hypoxic ischemic encephalopathy(HIE),coagulation disorders,disseminated intravascular coagulation,hypokalemia and hypocalcemia between the two groups(P>0.05).3.Comparison of clinical treatment of preterm infants between the IVF group and control group.There was no significant difference between the pediatric patients in the two groups during hospitalization in the use rate of pulmonary surfactant,caffeine,noninvasive assisted ventilation and mechanical ventilation(P>0.05);And there was no significant difference in the time of noninvasive assisted ventilation,mechanical ventilation,required parenteral nutrition and the hospitalization time between the two groups(P>0.05).4.Comparison of the general clinical data of maternal between IVF group and control group.The average age of maternal in the IVF group was(31.78 ± 4.18)years old,and that in the control group was(30.25±4.98)years old.There was significant difference in the average age of maternal between the two groups(t=6.727,P=0.001).In the IVF group,the proportion of primiparas and single chorionic twins was 88.9%and 8%,and that of the control group was 41.4%and 52.5%,respectively.There were significant differences in the proportion of primparas and single chorionic twinsbetween the two groups(?2value were 109.642 and 93.127,P value was 0.000).5.Comparison of pregnancy complications between IVF group and control group.5.1 The total incidence rate of pregnancy complications in the IVF group was 70.9%(141/199),the incidence rate of pregnancy hypertensionand hypothyroidism was 29.6%(59/199)and 29.1%(58/199),respectively;The total incidence rate of pregnancy complications in the control group was 56.6%(112/198),the incidence rateof pregnancy hypertension and hypothyroidism was 20.7%(41/198)and 14.1%(28/198),respectively.There were significant differences in the incidence rate of pregnancy complications,pregnancy hypertension and hypothyroidism between the two groups(x2value were8.766?4.211 and 13.167,P value were0.003?0.040 and 0.000).5.2 The incidence rate preterm premature rupture of membranes(PPROM)in the IVF group was 38.2%(76/199),mean time of PPROM was(106.87±184.66)hours;The incidence rate of PPROM in the control group was(22.2%)(44/198),mean time of PPROM was(50.59±85.72)hours.There was significant difference in the incidence rate of PPROM between the two groups(?2=12.000,P=0.01);there was significant difference in the mean time of PPROM between the two groups(t=7.622,P=0.026).5.3The incidence rate of maternal antenatal fever in IVF group 7.5%(15/199),and the use rate of antenatal antibiotic was 20.6%(41/199);The incidence rate of maternal antenatal fever in the control group was 2.0%(4/198),and the use rate of antenatal antibiotic was 11.6%(23/198).The incidence rate of maternal antenatal fever and antibiotic usage in the two groups were statistically significant(?2value were6.630 and 8.013,P value were 0.01 and 0.014).Conclusion:1.During the data collection period,the overall premature birth rate in the First Affiliated Hospital of Kunming Medical University was 11.1%,the rate of preterm birth in twins was 54.4%,the preterm delivery rate in IVF twins was 50.8%,and the proportion of IVF twin preterm infants in total twin preterm infants was 39.3%.2.Compared with spontaneously-conceived twin preterm infants,the sex ratio of male and female in IVF twin premature infants was higher,and the incidence rate of neonatal hyperbilirubinemia,THOP and ASD were higher in IVF twin premature infants,while the incidence of TTTS was lower.3.The average age of maternal with IVF twins was older than that with spontaneously-conceived twin pregnancies,and the proportion of primiparas was higher,the incidence rate of monochorionic twin was lower.The incidence rate of pregnancy hypertension,hypothyroidism,PPROM and antenatal fever in maternal with IVF twins preterm infants was higher,and the average time of PPROM was longer,and the use rate of antibiotics was higher.4.In conclusion,the health risk of IVF twin preterm infants was higher. |
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