双胎妊娠增重适宜范围与母婴围产期结局的关系  

The relationship between the appropriate gestational weight gain range in twin pregnancy and maternal and neonatal perinatal outcomes

作　　者：王丽娟[1] 林东鑫 陈宝珊 郭惠筱 于丹丹[1] 阳杏妮 杨洁[1] 冯锦屏[1] WANG Li Juan;LIN Dong Xin;CHEN Bao Shan;GUO Hui Xiao;YU Dan Dan;YANG Xing Ni;YANG Jie;FENG Jin Ping(Foshan Women and Children Hospital,Foshan 528000,Guangdong Province,China)

机构地区：[1]佛山市妇幼保健院,广东佛山528000

出　　处：《中国妇幼卫生杂志》2024年第3期63-68,共6页Chinese Journal of Women and Children Health

基　　金：中国疾病预防控制中心妇幼保健中心2022年度“母婴营养与健康研究项目”(2022FYH024);广东省佛山市“十四五”医学重点专科建设项目。

摘　　要：目的 探讨双胎妊娠孕妇孕中、晚期适宜的孕期体重增长(gestational weight gain,GWG)范围,并进一步分析GWG范围与母婴围产期妊娠结局的关系。方法 选取2012年1月—2022年12月于广东省佛山市妇幼保健院建档产检并分娩的2 222例双胎妊娠孕妇为研究对象,根据体质指数(body mass index,BMI)将孕妇分为低体重组、正常体重组、超重组及肥胖组。根据围产期结局确定低风险人群,采用四分位数法计算该人群孕中、晚期每周增重的适宜范围,并将双胎妊娠孕妇增重情况分为增重不足、增重适宜和增重过多。采用多因素logistic回归模型分别分析增重情况与6种围产期结局的关系,对新生儿结局采用广义估计方程进行分析。结果 不同BMI组别间初产妇占比、绒毛膜性、受孕方式的比较差异均有统计学意义(均P <0.05)。对于围产期结局,不同BMI组别间妊娠期糖尿病、妊娠期高血压和大于胎龄儿的比较差异均有统计学意义(均P<0.05)。根据819例低风险孕妇计算得出低体重组、正常体重组、超重组和肥胖组每周体重增长适宜范围分别为0.579~0.808 kg、0.531~0.769 kg、0.479~0.711 kg和0.430~0.679 kg。多因素logistic回归模型提示,GWG不足会增加早产(OR=1.36,95%CI:1.11~1.67)、小于胎龄儿(OR=1.74,95%CI:1.34~2.27)的发生风险,而GWG过多则会增加子痫前期(OR=1.82,95%CI:1.30~2.54)、妊娠期高血压(OR=1.72,95%CI:1.04~2.86)和大于胎龄儿(OR=2.17,95%CI:1.52~3.11)的发生风险。结论 基于低风险人群孕中、晚期GWG的适宜范围,双胎妊娠孕妇GWG增重过多或过少都会增加不良妊娠结局的风险,加强对双胎妊娠孕妇的体重管理有助于促进双胎妊娠孕妇母婴围产期健康。Objective Appropriate gestational weight gain(GWG)can reduce the risk of adverse maternal and neonatal outcomes.This study aimed to explore the appropriate range of GWG during the second and third trimesters of twin pregnancy,and further explore the relationship between GWG and maternal and neonatal perinatal outcomes in twin pregnancies.Methods A total of 2222 pregnant women with twin pregnancies who had prenatal examination and delivery in the Foshan Women and Children Hospital from January 2012 to December 2022 were included in this study.Body mass index(BMI)of pregnant women was calculated based on weight and height in the first trimester.These women were divided into underweight(<18.5 kg/m2),normal weight(18.5-23.9 kg/m2),overweight(24.0-27.9 kg/m2)and obesity group(≥28.0 kg/m2).According to perinatal outcomes,the low-risk population was determined,and the appropriate range of weekly GWG in the second and third trimesters of pregnancy was calculated using the inter quartile range(IQR)method.According to the appropriate ranges,pregnant women with twin pregnancies were divided into insufficient GWG,appropriate GWG,and excessive GWG.To verify these ranges,logistic regression models were performed based on the perinatal outcomes.Generalized estimation equation(GEE)was used to analyze neonatal outcomes.Results There were statistically significant differences in nulliparity,chorionicity,and conception method among different BMI groups(all P<0.05).For perinatal outcomes,there were statistically significant differences in gestational diabetes mellitus(GDM),gestational hypertension(GH),and large for gestational age(LGA)(all P<0.05).Based on 819 low-risk pregnant women,the appropriate ranges of weekly GWG for the underweight,normal-weight,overweight,and obese groups were 0.579-0.808 kg/week,0.531-0.769 kg/week,0.479-0.711 kg/week and 0.430-0.679 kg/week,respectively.Multivariable logistic regression model suggested that insufficient GWG increased the risk of preterm birth(PTB)(OR=1.36,95%CI:1.11-1.67)and small for g

关 键 词：双胎妊娠 孕前体质指数 孕期增重 母婴结局 

分 类 号：R714.23[医药卫生—妇产科学]