Twinning and major birth defects, National Birth Defects Prevention Study, 1997-2007
Twinning and major birth defects, National Birth Defects Prevention Study, 1997-2007
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DOI：
10.1136/jech-2015-206302
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发表时间：
2016-11-01
影响因子：
6.3
通讯作者：
Reefhuis, Jennita
中科院分区：
文献类型：
--
作者：
Dawson, April L.;Tinker, Sarah C.;Reefhuis, Jennita
背景 尽管之前的研究结果不一致，但双胞胎与多种类型的出生缺陷有关。许多研究缺乏有关潜在混杂因素的信息，尤其是生育治疗的使用。我们的目的是在国家出生缺陷预防研究 (NBDPS) 中评估双胞胎与出生缺陷之间的关联。方法我们使用 NBDPS（一项针对美国主要出生缺陷的基于人群的病例对照研究）的数据来评估双胞胎与出生缺陷之间的关联。研究人群包括双胞胎和单胎对照（无重大出生缺陷的活产婴儿）的母亲，以及 1997 年 10 月至 2007 年 12 月出生的病例（有重大出生缺陷的胎儿或婴儿）。调整后的 OR 和 95% CI 使用按生育治疗分层的多变量逻辑回归进行估计。使用双胞胎性别配对数据和模拟方法来估计双胞胎的合子性。结果在无辅助受孕层中，我们观察到双胞胎与 45 个缺陷组中的 29 个之间存在显着的正相关。观察到多发性室间隔缺损和泄殖腔外翻的最大效应估计。在报告使用生育治疗的母亲中，我们观察到 25 个缺陷组中的 5 个与双胞胎显着相关，其中对左心发育不全综合征和脐膨出的影响估计最大。估计的同卵异卵层中的 OR 估计值通常比双卵异卵层中的 OR 估计值更远离零值。 结论 与单胎相比，多种出生缺陷在双胞胎中更为常见。双胞胎的出生缺陷风险可能因生育治疗的使用而有所不同。
Background Twinning has been associated with many types of birth defects, although previous studies have had inconsistent findings. Many studies lack information about potential confounders, particularly use of fertility treatment. Our objective was to assess the association between twinning and birth defects in the National Birth Defects Prevention Study (NBDPS).Methods We used data from the NBDPS, a population-based, case-control study of major birth defects in the USA, to evaluate associations between twinning and birth defects. The study population included mothers of twin and singleton controls (live-born infants without major birth defects), and cases (fetuses or infants with a major birth defect) born October 1997-December 2007. Adjusted ORs and 95% CIs were estimated using multivariable logistic regression stratified by use of fertility treatment. Twin sex-pairing data and a simulation approach were used to estimate the zygosity of twins.Results In the unassisted conception stratum, we observed significant positive associations between twinning and 29 of 45 defect groups. The largest effect estimates were observed for multiple ventricular septal defects and cloacal exstrophy. Among mothers reporting any use of fertility treatments, we observed a significant association with twinning for 5 of 25 defect groups, with the largest effect estimates for hypoplastic left heart syndrome and omphalocele. OR estimates in the estimated monozygotic stratum were generally further from the null than in the dizygotic stratum.Conclusions Compared with singletons, a wide range of birth defects are significantly more common among twins. Birth defect risk in twins may be differential by use of fertility treatment.