双胎妊娠孕妇孕期体重增加与不良围产结局的关系  

Association between gestational weight gain in twin pregnancies with adverse perinatal outcomes

作　　者：李洋洋[1] 刘捷[1] 侯林 马紫君 曾超美[1] 秦炯[1] 吴燕秋[2] Li Yangyang;Liu Jie;Hou Lin;Ma Zijun;Zeng Chaomei;Qin Jiong;Wu Yanqiu(Department of Pediatrics,Peking University People's Hospital,Beijing 100044,China;Medical Information Center,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院儿科,北京100044 [2]北京大学人民医院信息中心,北京100044

出　　处：《中华围产医学杂志》2024年第8期617-623,共7页Chinese Journal of Perinatal Medicine

基　　金：北京市临床重点专科项目(2018)(2199000726);北京大学人民医院研究与发展基金(RDX2022-10)。

摘　　要：目的探讨双胎妊娠孕妇孕期体重增加(gestational weight gain,GWG)与不良围产结局的关系。方法回顾性纳入2012年1月至2022年10月在北京大学人民医院孕周≥25周活产分娩的双胎妊娠孕妇及其子代为研究对象。孕期总GWG按照孕周进行标准化处理,并根据2009年美国医学研究所(Institute of Medicine,IOM)指南分为增重不足(GWG低于IOM指南推荐)、增重适宜(GWG在IOM指南推荐范围之内)和增重过多(GWG高于IOM指南推荐)3组。3组间一般资料及围产结局比较采用方差分析、Kruskal-Wallis检验及Bonferroni校正或χ^(2)分割法。采用多变量logistic回归模型和广义估计方程中的logistic回归模型分别分析GWG对母亲及新生儿不良结局的独立影响。结果本研究共纳入794例双胎妊娠孕妇及其1588例活产新生儿。增重适宜、增重不足和增重过多3组孕妇分别有360例(45.3%)、356例(44.8%)和78例(9.8%)。增重不足和增重过多均与早产的风险增加有关[校正OR值分别为1.39(95%CI:1.04~1.88)和1.70(95%CI:1.05~2.78)]。GWG增重不足与妊娠期糖尿病(校正OR=1.42,95%CI:1.00~2.01)、低出生体重儿(校正OR=2.04,95%CI:1.57~2.66)的风险增加有关;与子痫或子痫前期(校正OR=0.50,95%CI:0.33~0.75)、剖宫产(校正OR=0.48,95%CI:0.30~0.77)、双胎发育不一致(校正OR=0.56,95%CI:0.37~0.85)、大于胎龄儿(校正OR=0.46,95%CI:0.35~0.61)的风险降低有关。增重过多与子痫或子痫前期(校正OR=2.85,95%CI:1.65~4.91)、大于胎龄儿(校正OR=2.49,95%CI:1.60~3.86)风险增加有关,与低出生体重儿的风险降低有关(校正OR=0.42,95%CI:0.27~0.65)。结论半数以上双胎妊娠孕妇GWG不在指南推荐范围。GWG低于或高于IOM指南推荐均与不良围产结局有关,尤其与早产风险增加有关。ObjectiveTo investigate the relationship between gestational weight gain(GWG)in twin pregnancies and adverse perinatal outcomes.MethodsThis retrospective study included twin pregnant women with live births at≥25 weeks of gestation and their offspring,who delivered at Peking University People's Hospital from January 2012 to October 2022.Total GWG was standardized according to gestational age and categorized into three groups based on the 2009 Institute of Medicine(IOM)guidelines:insufficient GWG(GWG below IOM recommendations),appropriate GWG(GWG within IOM recommendations),and excessive GWG(GWG above IOM recommendations).Comparisons between data of the three groups used analysis of variance,Kruskal-Wallis test or Bonferroni correction or Chi-square partitions.Multivariable logistic regression models and generalized estimating equations with logistic regression models were used to analyze the independent effects of GWG on maternal and neonatal outcomes.ResultsA total of 794 twin pregnant women and their 1588 live-born neonates were included in the study.There were 360 women(45.3%)with appropriate GWG,356(44.8%)with insufficient GWG,and 78(9.8%)with excessive GWG.Both insufficient and excessive GWG were associated with an increased risk of preterm birth[adjusted ORs of 1.39(95%CI:1.04-1.88)and 1.70(95%CI:1.05-2.78),respectively].Insufficient GWG was associated with an increased risk of gestational diabetes mellitus(adjusted OR=1.42,95%CI:1.00-2.01)and low birth weight infants(adjusted OR=2.04,95%CI:1.57-2.66).Insufficient GWG was also associated with a reduced risk of eclampsia or preeclampsia(adjusted OR=0.50,95%CI:0.33-0.75),cesarean section(adjusted OR=0.48,95%CI:0.30-0.77),discordant twin growth(adjusted OR=0.56,95%CI:0.37-0.85),and large for gestational age infants(adjusted OR=0.46,95%CI:0.35-0.61).Excessive GWG was associated with an increased risk of eclampsia or preeclampsia(adjusted OR=2.85,95%CI:1.65-4.91),and large for gestational age infants(adjusted OR=2.49,95%CI:1.60-3.86),while with a decreased risk

关 键 词：妊娠期体重增加 双胎妊娠 早产 妊娠期高血压疾病 妊娠期糖尿病 双胎发育不一致 

分 类 号：R714.23[医药卫生—妇产科学]