Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
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Perinatal Outcomes of In Vitro Fertilized Twins in Women of Advanced Age

고연령 산모에서 체외 수정 시술로 태어난 쌍생아의 임상 양상

  • Chung, In-Hyuk (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Kim, Sung-Woo (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Jo, Heui-Seung (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Lee, Kyu-Hyung (Department of Pediatrics, CHA Bundang Medical Center, CHA University)
  • 정인혁 (CHA의과학대학교 소아과학교실) ;
  • 김성우 (CHA의과학대학교 소아과학교실) ;
  • 조희승 (CHA의과학대학교 소아과학교실) ;
  • 이규형 (CHA의과학대학교 소아과학교실)
  • Published : 2011.11.30
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Abstract

Purpose: The purpose of this study is to compare perinatal outcomes between in vitro fertilization (IVF) twins and naturally conceived twins born to women aged 35 years or older and to provide basic information for taking care of IVF twins born to women aged 35 years or older. Methods: We reviewed the records of perinatal and neonatal outcomes in 288 IVF twins and 220 naturally conceived twins born to women aged 35 years or older between January 2001 and December 2010 at CHA Bundang Medical Center. Results: No difference was observed in the maternal ages of mothers giving birth to IVF twins and those giving birth to naturally conceived twins. Gestational ages and birth weights of IVF twins were not different from those of naturally conceived twins. Various perinatal outcomes, including gestational diabetes mellitus, pregnancy-induced hypertension, placenta previa, premature amniotic membrane rupture, and need for a Cesarean section did not differ between the 2 groups. However, the 1-min and 5-min Apgar scores (P=0.019 and P=0.045, respectively) were different between the 2 groups. The incidence of early-onset sepsis was lower in the IVF twins than in the naturally conceived twins (P=0.02). However, the 2 groups did not show any difference in the incidence of respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, and other congenital anomalies. Conclusion: The perinatal outcomes in IVF twins born to women aged 35 years or older were not significantly different from those of naturally conceived twins.

목적: 35세 이상 산모에서 체외 수정 시술을 통해 출생한 쌍생아와 자연 임신 쌍생아의 임상 양상을 비교하여 35세 이상 산모와 체외 수정 시술로 출생한 신생아 관리에 기초 자료 제공을 위하여 실시하였다. 방법: 2001년 1월 1일부터 2010년 12월 31일 사이 분당차병원에서 출생한 쌍생아 중 산모의 나이가 35세 이상인 신생아 508례를 대상으로 하여, 체외 수정 시술을 시행 받은 288례와 자연 임신군 220례 사이의 주산기 특성과 합병증 및 신생아기 질환발생의 차이를 의무 기록을 통해 후향적으로 조사하였다. 결과: 체외 수정 시술군과 자연 수정군 사이의 산모 연령은 (36.7${\pm}$2.07세 vs. 36.8${\pm}$2.18세, P=0.57)로 통계적 차이는 보이지 않았다. 재태 연령($36^{+0}{\pm}1^{+5}$주 vs. $36^{+0}{\pm}2^{+0}$주, P=0.95), 출생체중(2,420${\pm}$440 g vs. 2,480${\pm}$460 g, P=0.14) 역시 차이는 보이지 않았다. 1분 아프가 점수(7.37${\pm}$1.19 vs. 7.09${\pm}$1.46, P=0.019)와 5분 아프가 점수(8.67${\pm}$0.84 vs. 8.51${\pm}$0.96, P=0.045)는 모두 체외 수정 시술군에서 높았다. 임신성 당뇨, 임신성 고혈압, 전치태반, 조기 양막 파수, 제왕 절개술, 부당 경량아의 빈도는 두 군간의 차이가 없었다. 조발형 패혈증의 빈도는 체외 수정 시술군에서 자연 수정군보다 낮았다(2.4% vs. 6.4%, P=0.02). 그밖에 신생아 호흡 곤란 증후군, 기관지 폐 형성이상, 동맥관 개존증, 신생아 괴사 장염, 뇌실 내 출혈의 발생 빈도는 모두 두 군 간에 차이가 없었다. 결론: 본 기관에서 지난 10년간 고연령 산모에서 체외 수정 시술로 태어난 쌍생아의 임상 양상을 조사하여 자연 수정으로 출생한 쌍생아와 비교하였을 때, 체외 수정 시술로 인하여 주산기 합병증과 신생아기 질환의 발생 빈도가 높아지지는 않았다.

Keywords

References

  1. Statistics Korea, Annual Report on Live Births and Deaths Statistics. 2010.
  2. Hansen JP. Older maternal age and pregnancy outcome: a review of the literature. Obstet Gynecol Surv 1986;41:726-42. https://doi.org/10.1097/00006254-198611000-00024
  3. Seoud MA, Nassar AH, Usta IM, Melhem Z, Kazma A, Khalil AM. Impact of advanced maternal age on pregnancy outcome. Am J Perinatol 2002;19:1-8. https://doi.org/10.1055/s-2002-20175
  4. Salem Yaniv S, Levy A, Wiznitzer A, Holcberg G, Mazor M, Sheiner E. A significant linear association exists between advanced maternal age and adverse perinatal outcome. Arch Gynecol Obstet 2011;283:755-9. https://doi.org/10.1007/s00404-010-1459-4
  5. Korean Society of Obstetrics and Gynecology. Current status of assisted reproductive technology in Korea, 2007. Korean J Obstet Gynecol 2010;53:1052-77. https://doi.org/10.5468/kjog.2010.53.12.1052
  6. Tan SL, Doyle P, Campbell S, Beral V, Rizk B, Brinsden P, et al. Obstetric outcome of in vitro fertilization pregnancies compared with normally conceived pregnancies. Am J Obstet Gynecol 1992;167:778-84. https://doi.org/10.1016/S0002-9378(11)91589-0
  7. Tough SC, Greene CA, Svenson LW, Belik J. Effects of in vitro fertilization on low birth weight, preterm delivery, and multiple birth. J Pediatr 2000;136:618-22. https://doi.org/10.1067/mpd.2000.105132
  8. Perri T, Chen R, Yoeli R, Merlob P, Orvieto R, Shalev Y, et al. Are singleton assisted reproductive technology pregnancies at risk of prematurity? J Assist Reprod Genet 2001;18:245-9. https://doi.org/10.1023/A:1016614217411
  9. Wang JX, Clark AM, Kirby CA, Philipson G, Petrucco O, Anderson G, et al. The obstetric outcome of singleton pregnancies following invitro fertilization/gamete intra-fallopian transfer. Hum Reprod 1994;9:141-6.
  10. Wang YA, Sullivan EA, Black D, Dean J, Bryant J, Chapman M. Preterm birth and low birth weight after assisted reproductive technology-related pregnancy in Australia between 1996 and 2000. Fertil Steril 2005;83:1650-8. https://doi.org/10.1016/j.fertnstert.2004.12.033
  11. Reubinoff BE, Samueloff A, Ben-Haim M, Friedler S, Schenker JG, Lewin A. Is the obstetric outcome of in vitro fertilized singleton gestations different from natural ones? A controlled study. Fertil Steril 1997;67:1077-83. https://doi.org/10.1016/S0015-0282(97)81442-2
  12. Kim KA, Min UG, Lim JW, Jun NL, Won HS, Kim CH, et al. Maternal and neonatal outcome of twin pregnancies after in vitro fertilization and embryo transfer. J Korean Pediatr Soc 2003;46:224-9.
  13. Kim HM, Lee JW, Shin SH, Kim SK, Sung TJ. Comparison of neonatal outcomes between the spontaneous and in vitro fertilization twin pregnancies. Korean J Pediatr 2007;50:740-5. https://doi.org/10.3345/kjp.2007.50.8.740
  14. Fitzsimmons BP, Bebbington MW, Fluker MR. Perinatal and neonatal outcomes in multiple gestations: assisted reproduction versus spontaneous conception. Am J Obstet Gynecol 1998;179:1162-7. https://doi.org/10.1016/S0002-9378(98)70125-5
  15. Rao A, Sairam S, Shehata H. Obstetric complications of twin pregnancies. Best Pract Res Clin Obstet Gynaecol 2004;18:557-76. https://doi.org/10.1016/j.bpobgyn.2004.04.007
  16. Yang H, Choi YS, Nam KH, Kwon JY, Park YW, Kim YH. Obstetric and perinatal outcomes of dichorionic twin pregnancies according to methods of conception: spontaneous versus in-vitro fertilization. Twin Res Hum Genet 2011;14:98-103. https://doi.org/10.1375/twin.14.1.98
  17. Kanat-Pektas M, Kunt C, Gungor T, Mollamahmutoglu L. Perinatal and first year outcomes of spontaneous versus assisted twins: a single center experience. Arch Gynecol Obstet 2008;278:143-7. https://doi.org/10.1007/s00404-007-0545-8
  18. Tomic V, Tomic J. Neonatal outcome of IVF singletons versus naturally conceived in women aged 35 years and over. Arch Gynecol Obstet 2011;284:1411-6. https://doi.org/10.1007/s00404-011-1873-2
  19. Lubchenco LO, Hansman C, Boyd E. Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26 to 42 weeks. Pediatrics 1966;37:403-8.
  20. Chiswick ML. Commentary on current World Health Organisation definitions used in perinatal statistics. Arch Dis Child 1986;61:708- 10. https://doi.org/10.1136/adc.61.7.708
  21. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-9. https://doi.org/10.1164/ajrccm.163.7.2011060
  22. Lee WR. Neonatal sepsis. J Korean Pediatr Soc 2002;45:289-94.
  23. Philip AG, Hewitt JR. Early diagnosis of neonatal sepsis. Pediatrics 1980;65:1036-41.
  24. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978;187:1-7. https://doi.org/10.1097/00000658-197801000-00001
  25. Volpe JJ. Intraventricular hemorrhage and brain injury in the premature infant. Diagnosis, prognosis, and prevention. Clin Perinatol 1989;16:387-411.
  26. Hsieh TT, Liou JD, Hsu JJ, Lo LM, Chen SF, Hung TH. Advanced maternal age and adverse perinatal outcomes in an Asian population. Eur J Obstet Gynecol Reprod Biol 2010;148:21-6. https://doi.org/10.1016/j.ejogrb.2009.08.022
  27. Koivurova S, Hartikainen AL, Gissler M, Hemminki E, Sovio U, Jarvelin MR. Neonatal outcome and congenital malformations in children born after in-vitro fertilization. Hum Reprod 2002;17:1391- 8. https://doi.org/10.1093/humrep/17.5.1391
  28. Sherman SL, Allen EG, Bean LH, Freeman SB. Epidemiology of Down syndrome. Ment Retard Dev Disabil Res Rev 2007;13:221-7. https://doi.org/10.1002/mrdd.20157
  29. Park HJ, Cho CY, Choi YY. Risk factors and prognosis of bronchopulmonary dysplasia. J Korean Soc Neonatol 1999;6:8-15
  30. Shim SY, Jung KE, Kim ES, Lee JA, Kim EK, Kim HS, et al. Clinical characteristics and predisposing factors in full-term and preterm neonates with necrotizing enterocolitis. J Korean Soc Neonatol 2005;12:79-86.
  31. Hwang MJ, Cho CY, Choi YY, Ma YR, Lim ST, Park YG. Retinopathy of prematurity and perinatal risk factor. J Korean Soc Neonatol 1999;6:106-15.

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