고연령 산모에서 체외 수정 시술로 태어난 쌍생아의 임상 양상
Perinatal Outcomes of In Vitro Fertilized Twins in Women of Advanced Age
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
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 제공을위하여 실시 하였다. 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 자연임신군 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±2.07세 vs. 36.8±2.18세, P=0.57)로 통계적 차이는 보이지 않았다. 재태 연령(36^(+0)±1^(+5)주 vs. 36^(+0)±2^(+0)주, P=0.95), 출생체중(2,420±440 g vs. 2,480±460 g, P=0.14) 역시 차이는 보이지 않았다. 1분 아프가 점수(7.37±1.19 vs. 7.09±1.46, P=0.019)와 5분 아프가 점수(8.67±0.84 vs. 8.51±0.96, P=0.045)는 모두체외 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 주산기합병증과 신생아기 질환의 발생 빈도가 높아지지는 않았다.
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.
참고문헌 (31)
- Annual Report on Live Births and Deaths Statistics, , Statistics Korea, ~ (2010)
- Hansen JP, "Older maternal age and pregnancy outcome: a review of the literature", Obstet Gynecol Surv, 41, pp.726~741 (1986)
- Seoud MA, "Impact of advanced maternal age on pregnancy outcome", Am J Perinatol, 19, pp.1~8 (2002)
- Salem Yaniv S, "A significant linear association exists between advanced maternal age and adverse perinatal outcome", Arch Gynecol Obstet, 283, pp.755~759 (2011)
- 보조생식술소위원회, "조사보고서 한국 보조생식술의 현황: 2007년", Obstetrics & Gynecology Science, 53(12), pp.1052~1077 (2010), 대한산부인과학회
- Tan SL, "Obstetric outcome of in vitro fertilization pregnancies compared with normally conceived pregnancies", Am J Obstet Gynecol, 167, pp.778~784 (1992)
- Tough SC, "Effects of in vitro fertilization on low birth weight, preterm delivery, and multiple birth", J Pediatr, 136, pp.618~622 (2000)
- Perri T, "Are singleton assisted reproductive technology pregnancies at risk of prematurity", J Assist Reprod Genet, 18, pp.245~249 (2001)
- Wang JX, "The obstetric outcome of singleton pregnancies following invitro fertilization", gamete intra-fallopian transfer, 1994, pp.9, 141~146
- Wang YA, "Preterm birth and low birth weight after assisted reproductive technology- related pregnancy in Australia between 1996 and 2000", Fertil Steril, 83, pp.1650~1658 (2005)
- Reubinoff BE, "Is the obstetric outcome of in vitro fertilized singleton gestations different from natural ones? A controlled study", Fertil Steril, 67, pp.1077~1083 (1997)
- 김경아, "체외수정시술로 출생한 쌍생아의 임상적 경과에 대한 비교 분석", Korean Journal of Pediatrics, 46(3), pp.224~229 (2003), 대한소아과학회
- 김희문, "인공수정 및 자연수정으로 태어난 쌍생아간 임상 양상 비교", Korean Journal of Pediatrics, 50(8), pp.740~745 (2007), 대한소아과학회
- Fitzsimmons BP, "Perinatal and neonatal outcomes in multiple gestations: assisted reproduction versus spontaneous conception", Am J Obstet Gynecol, 179, pp.1162~1167 (1998)
- Rao A, "Obstetric complications of twin pregnancies", Best Pract Res Clin Obstet Gynaecol, 18, pp.557~576 (2004)
- Yang H, "Obstetric and perinatal outcomes of dichorionic twin pregnancies according to methods of conception: spontaneous versus in-vitro fertilization", Twin Res Hum Genet, 14, pp.98~103 (2011)
- Kanat-Pektas M, "Perinatal and first year outcomes of spontaneous versus assisted twins: a single center experience", Arch Gynecol Obstet, 278, pp.143~147 (2008)
- Tomic V, "Neonatal outcome of IVF singletons versus naturally conceived in women aged 35 years and over", Arch Gynecol Obstet, 284, pp.1411~1416 (2011)
- Lubchenco LO, "Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26 to 42 weeks", Pediatrics, 37, pp.403~408 (1966)
- Chiswick ML, "Commentary on current World Health Organisation definitions used in perinatal statistics", Arch Dis Child, 61, pp.708~710 (1986)
- Jobe AH, "Bronchopulmonary dysplasia", Am J Respir Crit Care Med, 163, pp.1723~1729 (2001)
- 이우령, "신생아 패혈증", Korean Journal of Pediatrics, 45(3), pp.289~294 (2002), 대한소아과학회
- Philip AG, "Early diagnosis of neonatal sepsis", Pediatrics, 65, pp.1036~1041 (1980)
- Bell MJ, "Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging", Ann Surg, 187, pp.1~7 (1978)
- Volpe JJ, "Intraventricular hemorrhage and brain injury in the premature infant. Diagnosis, prognosis, and prevention", Clin Perinatol, 16, pp.387~411 (1989)
- Hsieh TT, "Advanced maternal age and adverse perinatal outcomes in an Asian population", Eur J Obstet Gynecol Reprod Biol, 148, pp.21~26 (2010)
- Koivurova S, "Neonatal outcome and congenital malformations in children born after in-vitro fertilization", Hum Reprod, 17, pp.1391~1398 (2002)
- Sherman SL, "Epidemiology of Down syndrome", Ment Retard Dev Disabil Res Rev, 13, pp.221~227 (2007)
- Park HJ, "Risk factors and prognosis of bronchopulmonary dysplasia", J Korean Soc Neonatol, 6, pp.8~15 (1999)
- Shim SY, "Clinical characteristics and predisposing factors in full-term and preterm neonates with necrotizing enterocolitis", J Korean Soc Neonatol, 12, pp.79~86 (2005)
- Hwang MJ, "Retinopathy of prematurity and perinatal risk factor", J Korean Soc Neonatol, 6, pp.106~115 (1999)