辅助生殖技术助孕双胎妊娠的管理策略

洪凡真

doi:10.19538/j.fk2025020109

PDF(912 KB)

中国实用妇科与产科杂志 ›› 2025, Vol. 41 ›› Issue (2) : 172-177. DOI: 10.19538/j.fk2025020109

专题笔谈

辅助生殖技术助孕双胎妊娠的管理策略

洪凡真

作者信息 +

Management strategies for assisted reproductive technology-assisted twin pregnancies

Fan-zhen HONG

Author information +

文章历史 +

摘要

近年来，随着辅助生殖技术的不断发展和国家生育政策的调整，孕产妇面临“高龄化”趋势，应用辅助生殖技术助孕的双胎妊娠比例也不断升高。双胎妊娠属于高危妊娠，较单胎妊娠更易引起各种产科合并症及并发症。辅助生殖技术助孕双胎妊娠由于其特殊性，不良妊娠结局的发生风险可能更高。为了提高辅助生殖技术助孕双胎妊娠的围产保健质量，并降低相关并发症的发生率，文章提供了一些关键的管理策略。

Abstract

In recent years，with the continuous development of assisted reproductive technology and the adjustment of China's fertility policy，pregnant women are facing the trend of "advanced age"，and the proportion of twin pregnancies assisted by assisted reproductive technology is also increasing. Twin pregnancies are high-risk pregnancies and are more likely to cause various obstetric comorbidities and complications than singleton pregnancies. Assisted reproductive technology（ART）-assisted twin pregnancy may be at a higher risk of adverse pregnancy outcomes due to its specificity. In order to improve the quality of perinatal care and reduce the incidence of related complications in assisted reproductive technology-assisted twin pregnancies，this article provides some key management strategies.

导出引用

洪凡真. 辅助生殖技术助孕双胎妊娠的管理策略[J]. 中国实用妇科与产科杂志. 2025, 41(2): 172-177 https://doi.org/10.19538/j.fk2025020109

Fan-zhen HONG. Management strategies for assisted reproductive technology-assisted twin pregnancies[J]. Chinese Journal of Practical Gynecology and Obstetrics. 2025, 41(2): 172-177 https://doi.org/10.19538/j.fk2025020109

中图分类号： R714.23

参考文献

列表( 原文顺序 | 文献年度倒序 | 文中引用次数倒序 ) 可视化分析

[1]	Chambers GM, Dyer S, Zegers-Hochschild F, et al. International Committee for Monitoring Assisted Reproductive Technologies world report:assisted reproductive technology,2014[J]. Hum Reprod, 2021, 36(11):2921-2934. DOI:10.1093/humrep/deab198. 本文引用 [1]

[2]	Wang Y, Shi H, Chen L, et al. Absolute risk of adverse obstetric outcomes among twin pregnancies after in vitro fertilization by maternal age[J]. JAMA Netw Open, 2021, 4(9):e2123634. DOI:10.1001/jamanetworkopen.2021.23634. 本文引用 [2]

[3]

国家产科专业医疗质量控制中心. 2022年国家产科医疗服务与质量安全报告[EB/OL]. (2023-04-10)[2024-12-20]. https://www.obqcc.org.cn/#/testing?id=2c9180828595dcc30187fee5d8ad0008&articleId=2c9180828595dcc301876b821ea50005.

https://www.obqcc.org.cn/#/testing?id=2c9180828595dcc30187fee5d8ad0008&articleId=2c9180828595dcc301876b821ea50005

本文引用 [1]

[4]	孙贻娟, 黄国宁, 孙海翔, 等. 关于胚胎移植数目的中国专家共识[J]. 生殖医学杂志, 2018, 27(10):940-945. DOI:10.3969/j.issn.1004-3845.2018.10.003. 本文引用 [1]

[5]	中华医学会生殖医学分会. 中国高龄不孕女性辅助生殖临床实践指南[J]. 中国循证医学杂志, 2019, 19(3):253-270. DOI:10.7507/1672-2531.201812103. 本文引用 [1]

[6]	Grady R, Alavi N, Vale R, et a1. Elective single embryo transfer and perinatal outcomes:a systematic review and meta-analysis[J]. Fertil Steril, 2012, 97:324-331. DOI:10.1016/j.fertnstert.2011.11.033. 本文引用 [1]

[7]	胡琳莉, 黄国宁, 孙海翔, 等. 多胎妊娠减胎术操作规范(2016)[J]. 生殖医学杂志, 2017, 26(3):193-198. DOI:10.3969/j.issn.1004-3845. 本文引用 [1]

[8]	Zemet R, Haas J, Bart Y, et al. Optimal timing of fetal reduction from twins to singleton:earlier the better or later the better?[J]. Ultrasound Obstet Gynecol, 2021, 57(1):134-140. 本文引用 [2]

[9]	中国医师协会妇产科医师分会, 中国医师协会营养医师专业委员会, 中华医学会围产医学分会. 孕前和孕期主要微量营养素补充专家共识(2024)[J]. 中华妇产科杂志, 2024, 59(10):737-746. DOI:10.3760/cma.j.cn112141-20240611-00326. 本文引用 [2]

[10]	中国营养学会.T/CNSS015-2022 孕期体重增长异常妇女膳食指导[S]. 北京: 中国营养学会, 2022. 本文引用 [1]

[11]	American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 548:weight gain during pregnancy[J]. Obstet Gynecol, 2013, 121(1):210-212. DOI:10.1097/01.aog.0000425668.87506.4c. 本文引用 [1]

[12]	Lipworth H, Barrett J, Murphy KE, et al. Gestational weight gain in twin gestations and pregnancy outcomes:a systematic review and meta-analysis[J]. BJOG, 2022, 129(6):868-879. DOI:10.1111/1471-0528.17011. 本文引用 [1]

[13]	Staneva A, Bogossian F, Pritchard M, et al. The effects of maternal depression,anxiety,and perceived stress during pregnancy on preterm birth:A systematic review[J]. Women Birth, 2015, 28(3):179-193. DOI:10.1016/j.wombi.2015.02.003. 本文引用 [1]

[14]	Acheampong K, Pan X, Kaminga AC, et al. Risk of adverse maternal outcomes associated with prenatal exposure to moderate-severe depression compared with mild depression:A fellow-up study[J]. J Psychiatr Res, 2021, 136:32-38. DOI:10.1016/j.jpsychires.2021.01.036. 本文引用 [1]

[15]	Hjelmstedt A, Widstrom AM, Wramsby H, et al. Personality factors and emotional responses to pregnancy among IVF couples in early pregnancy:a comparative study[J]. Acta Obstet Gynecol Scand, 2003, 82(2):152-161. DOI:10.1034/j.1600-0412.2003.00040.x. 本文引用 [1]

[16]	Furmli H, Seeto RA, Hewko SL, et al. Maternal mental health in assisted and natural conception:a prospective cohort study[J]. J Obstet Gynaecol Can, 2019, 41(11):1608-1615. 本文引用 [1]

[17]	王予, 李骋, 刘含. 辅助生殖和自然受孕女性围产期心理健康的差异:一项前瞻性队列研究[J]. 中华生殖与避孕杂志, 2023, 43(3):269-275. DOI:10.3760/cma.j.cn101441-20211208-00547. 本文引用 [1]

[18]	Aurora O, Stella T, Anne K, et al. Anxiety and depression in expectant parents:ART versus spontaneous conception[J]. Human Reproduction, 2023, 38(9):1755-1760. DOI:10.1093/humrep/dead133. 本文引用 [1]

[19]	Fu W, Wilhelm LO, Wei Y, et al. Emotional intelligence and dyadic satisfaction buffer the negative effect of stress on prenatal anxiety and depressive symptoms in Chinese women who are pregnant with twins[J]. Anxiety Stress Coping, 33(4):466-478. DOI:10.1080/10615806.2020.1745193. 本文引用 [1]

[20]	Omer W, Jon B, Kellie EM, et al. National and international guidelines on the management of twin pregnancies:a comparative review[J]. Am J Obstet Gynecol, 2023, 229(6):577-598. DOI:10.1016/j.ajog.2023.05.022. 本文引用 [2]

[21]	Parazzini F, Cipriani S, Bianchi S, et al. Risk of monozygotic twins after assisted reproduction:a population-based approach[J]. Twin Res Hum Genet, 2016, 19(1):72-76. DOI:10.1017/thg.2015.96. 本文引用 [1]

[22]	Vitthala S, Gelbaya TA, Brison DR, et al. The risk of monozygotic twins after assisted reproductive technology:a systematic review and meta-analysis[J]. Hum Reprod Update, 2009, 15(1):45-55. DOI:10.1093/humupd/dmn045. 本文引用 [1]

[23]	Skiadas CC, Missmer SA, Benson CB, et al. Risk factors associated with pregnancies containing a monochorionic pair following assisted reproductive technologies[J]. Hum Reprod, 2008, 23(6):1366-1371. DOI:10.1093/humrep/den045. 本文引用 [1]

[24]	泮思林, 罗刚. 推进中国胎儿结构性心脏病宫内干预的相关问题与对策[J]. 中国实用儿科杂志, 2021, 36(05):332-335.DOI:10.19538/j.ek2021050604. 本文引用 [1]

[25]	Luke B, Brown MB, Wantman E, et al. The risk of birth defects with conception by ART[J]. Hum Reprod, 2021, 36(1):116-129. DOI:10.1093/humrep/deaa272. 本文引用 [1]

[26]	Matthew KJ, Lisa DL, Bryann B, et al. Clinical implications of crown-rump length discordance at 11 to 14 weeks in dichorionic twins[J]. Am J Obstet Gynecol, 2024, 230(1):83.e1-83.e11. DOI:10.1016/j.ajog.2023.07.029. 本文引用 [2]

[27]	ACOG Committee. Multifetal gestations:twin,triplet,and higher-order multifetal pregnancies:ACOG practice bulletin,number 231[J]. Obstet Gynecol, 2021, 137(6):e145-e162. DOI:10.1097/AOG.0000000000004397. 本文引用 [1]

[28]	吴凯佳, 贾燕, 张国华, 等. 辅助生殖技术受孕对双绒毛膜双羊膜囊双胎妊娠早产发生风险的影响研究[J]. 中国实用妇科与产科杂志, 2024, 40(2):235-238.DOI:10.19538/j.fk2024020121. 本文引用 [1]

[29]	Wang YP, Ray JG, Pudwell J, et al. Mode of conception and risk of spontaneous vs. provider-initiated preterm birth:population-based cohort study[J]. Fertil Steril, 2022, 118(5):926-935. DOI:10.1016/j.fertnstert.2022.07.028. 本文引用 [1]

[30]	Cavoretto P, Candiani M, Giorgione V, et al. Risk of spontaneous preterm birth in singleton pregnancies conceived after IVF/ICSI treatment:meta-analysis of cohort studies[J]. Ultrasound Obstet Gynecol, 2018, 51(1):43-53. DOI:10.1002/uog.18930. 本文引用 [1]

[31]	Wang L, Cheng L, Zhang S, et al. Mediation effect of pregnancy-induced hypertension on the association between assisted reproductive technology and adverse neonatal outcomes:a population-based study[J]. BMC Pregnancy Childbirth, 2023, 23(1):385. DOI:10.1186/s12884-023-05694-3. 本文引用 [1]

[32]	Ban M, Sun Y, Chen X, et al. Association between maternal polycystic ovarian syndrome undergoing assisted reproductive technology and pregnancy complications and neonatal outcomes:a systematic review and meta-analysis[J]. J Ovarian Res, 2024, 17(1):1-12. DOI:10.1186/s13048-023-01331-x. 本文引用 [1]

[33]	中华医学会围产医学分会胎儿医学学组, 中华医学会妇产科学分会产科学组. 双胎妊娠临床处理指南(2020 年更新)[J]. 中华围产医学杂志, 2020, 23(8):505-516. DOI:10.3760/cma.j.cn113903-20200812-00793. 本文引用 [2]

[34]	Wang YA, Chughtai AA, Farquhar CM, et al. Increased incidence of gestational hypertension and preeclampsia after assisted reproductive technology treatment[J]. Fertil Steril, 2016, 105(4):920-926.e2. DOI:10.1016/j.fertnstert.2015.12.024. 本文引用 [1]

[35]	Kim MS, Jang JH, Park S, et al. Effect of adenomyosis on adverse obstetrical outcomes in twin pregnancies achieved with assisted reproductive technology[J]. J Obstet Gynaecol, 2021, 41(8):1225-1229. DOI:10.1080/01443615.2020.1867969. 本文引用 [1]

[36]	中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南(2020)[J]. 中华妇产科杂志, 2020, 55(4):227-238. DOI:10.3760/cma.j.cn112141-20200114-00039. 本文引用 [1]

[37]	Li R, Zhang Q, Yang D, et al. Prevalence of polycystic ovary syndrome in women in China:a large community-based study[J]. Hum Reprod, 2013, 28(9):2562-2569. DOI:10.1093/humrep/det262. 本文引用 [1]

[38]	Wu Q, Gao J, Bai D, et al. The prevalence of polycystic ovarian syndrome in Chinese women:a meta-analysis[J]. Ann Palliat Med, 2021, 10(1):74-87. DOI:10.21037/apm-20-1893. 本文引用 [1]

[39]	张孝东, 邓成艳, 黄学锋, 等. 中华医学会生殖医学分会:2019年辅助生殖技术数据报告[J]. 生殖医学杂志, 2022, 31(8):1015-1021. DOI:10.3969/j.issn.1004-3845.2022.08.001. 本文引用 [1]

[40]	Ashwal E, Berger H, Hiersch L, et al. Gestational diabetes and fetal growth in twin compared with singleton pregnancies[J]. Am J Obstet Gynecol, 2021, 225(4):420.e1-420.e13. DOI:10.1016/j.ajog.2021.04.225. 本文引用 [1]

[41]	Fox NS, Gerber RS, Saltzman DH, et al. Glycemic control in twin pregnancies with gestational diabetes:are we improving or worsening outcomes[J]. J Matern Fetal Neonatal Med, 2015, 29(7):1041-1045. DOI:10.3109/14767058.2015.1038517. 本文引用 [1]

[42]	Shemoon M, Wasana K, Ruvini N, et al. Maternal and perinatal outcomes in twin pregnancies following assisted reproduction:a systematic review and meta-analysis involving 802462 pregnancies[J]. Hum Reprod Update, 2024, 30(3):309-322. DOI:10.1093/humupd/dmae002. 本文引用 [1]

[43]	Sun L, Zou G, Wei X, et al. Clinical outcomes after assisted reproductive technology in twin pregnancies:chorionicity-based comparison[J]. Sci Rep, 2016,6:1-7. DOI:10.1038/srep26869. 本文引用 [1]

[44]	Seravalli V, Maoloni L, Pasquini L, et al. The impact of assisted reproductive technology on prenatally diagnosed fetal growth restriction in dichorionic twin pregnancies[J]. PLoS One, 2020, 15(4):1-10. DOI:10.1371/journal.pone.0231028. 本文引用 [1]

[45]	Kondowe FJM, Clayton P, Gittins M, et al. Growth of twins conceived using assisted reproductive treatments up to 5 years old:a national growth cohort[J]. Hum Reprod, 2023, 38(4):751-761. DOI:10.1093/humrep/dead018. 本文引用 [1]

[46]	赫英东, 李雨利, 陈倩. 双胎妊娠胎儿发育不均衡的妊娠结局[J]. 中华围产医学杂志, 2014, 17(02):78-81. DOI:10.3760/cma.j.issn.1007-9408.2014.02.002. 本文引用 [1]

[47]	Miller J, Chauhan SP, Abuhamad AZ. Discordant twins:diagnosis, evaluation and management[J]. Am J Obstet Gynecol, 2012, 206:10-20. DOI:10.1016/j.ajog.2011.06.075. 本文引用 [1]

[48]	Khalil A, Beune I, Hecher K, et al. Consensus definition and essential reporting parameters of selective fetal growth restriction in twin pregnancy:a Delphi procedure[J]. Ultrasound Obstet Gynecol, 2019, 53(1):47-54. DOI:10.1002/uog.19013. 本文引用 [1]