Hospital care utilization of IVF/ICSI twins followed until 2-7 years of age: a controlled Danish national cohort study
Hospital care utilization of IVF/ICSI twins followed until 2-7 years of age: a controlled Danish national cohort study
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DOI：
10.1093/humrep/deh474
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发表时间：
2004-11-01
影响因子：
6.1
通讯作者：
Andersen, AN
中科院分区：
文献类型：
--
作者：
Pinborg, A;Loft, A;Andersen, AN
背景：IVF/ICSI 双胞胎可能有较高的早产风险，且发病率较高。本研究的目的是根据 2-7 岁之前检索的数据来评估 IVF/ICSI 双胞胎的医院护理资源的使用情况。方法：对 1995 年至 2000 年间出生的丹麦 3393 名 IVF 双胎、10239 名自然受孕双胞胎和 5130 名 IVF 单胎进行入院和手术干预的国家对照队列研究。丹麦体外受精登记处和国家患者登记处的数据的交叉链接使我们能够识别入院或接受手术的儿童。结果：IVF/ICSI 双胎、对照双胎和 IVF/ICSI 单胎中住院儿童的频率分别为 69.8%、69.6% 和 49.8%，接受手术干预的儿童频率分别为 10.6%、11.2% 和 8.5%。 IVF/ICSI 双胎与对照双胞胎和 IVF/ICSI 单胎的住院比值比 (OR)（95% 置信区间）分别为 1.04 (0.96, 1.14) 和 2.44 (2.22, 2.63)，根据出生年份、母亲年龄和胎次调整后的 OR 分别为 1.00 (0.91, 1.11) 和 2.38分别为（2.17，2.63）。同样对于足月婴儿，IVF/ICSI 双胎比 IVF/ICSI 单胎更有可能住院：调整后 OR 1.37 (1.22, 1.51)。在 IVF/ICSI 与对照双胞胎中观察到类似的手术风险。然而，IVF/ICSI 双胞胎比 IVF/ICSI 单胞胎更常接受手术干预：调整后 OR 1.26 (1.08, 1.47)。当仅限于足月婴儿时，这种风险就消失了：调整后的 OR 1.00 (0.81, 1.22)。不同性别IVF/ICSI和对照双胞胎的入院和手术干预风险相同，ICSI儿童与传统IVF后出生的儿童具有相同的风险。结论：虽然 IVF/ICSI 和对照双胞胎对医院护理资源的使用相似，但 IVF/ICSI 双胎与 IVF/ICSI 单胎的过度使用增加了将选择性单胚胎移植作为我们的标准程序实施的争论。
Background: IVF/ICSI twins are likely to have a higher risk of prematurity associated with higher morbidity. The aim of this study was to assess the use of hospital care resources in IVF/ICSI twins on data retrieved until 2-7 years of child age. Methods: National controlled cohort study on hospital admissions and surgical interventions in 3393 IVF twins, 10 239 spontaneously conceived twins and 5130 IVF singletons born between 1995 and 2000 in Denmark. Cross-linkage of data from the Danish IVF Registry and the National Patient Registry enabled us to identify children who were admitted to hospital or underwent an operation. Results: The frequency of hospitalized children was 69.8, 69.6 and 49.8%, and of children who underwent a surgical intervention 10.6, 11.2 and 8.5% in IVF/ICSI twins, control twins and IVF/ICSI singletons respectively. Odds ratios (OR) (95% confidence intervals) of hospitalization in IVF/ICSI twins versus control twins and IVF/ICSI singletons were 1.04 (0.96, 1.14) and 2.44 (2.22, 2.63) and OR adjusted for year of birth, maternal age and parity were 1.00 (0.91, 1.11) and 2.38 (2.17, 2.63) respectively. Also for term birth infants, IVF/ICSI twins were more likely to be hospitalized than IVF/ICSI singletons: adjusted OR 1.37 (1.22, 1.51). Similar risk of a surgical procedure was observed in IVF/ICSI versus control twins. However, IVF/ICSI twins more often underwent a surgical intervention than IVF/ICSI singletons: adjusted OR 1.26 (1.08, 1.47). This risk disappeared when restricted to term infants: adjusted OR 1.00 (0.81, 1.22). Different sex IVF/ICSI and control twins had equal risk of admissions and surgical interventions, and ICSI children had the same risk as children born after conventional IVF. Conclusions: Though the use of hospital care resources was similar in IVF/ICSI and control twins, the over-use in IVF/ICSI twins versus IVF/ICSI singletons adds to the arguments for implementing elective single embryo transfer as our standard procedure.