妊娠期糖尿病对双胎妊娠孕妇的母儿结局及双生子12月龄生长状况影响的巢式病例对照研究

Effects of Twin Pregnancies with Gestational Diabetes Mellitus on Perinatal Outcomes and Growth of Twin Children within 12 Months of Age:A Nested Case-Control Study

目的:评估妊娠期糖尿病(GDM)对双胎妊娠孕妇的母儿围产期结局对双生子12月龄内生长发育的影响。方法:采用巢式病例对照研究,根据口服葡萄糖耐量试验(OGTT)结果,将研究对象分为GDM组和无GDM组(Non-GDM组),记录并描述两组间的围产期结局以及双生子0~12月龄的生长情况。结果:总计507例双胎妊娠孕妇被纳入研究,其中GDM组137例和Non-GDM组370例。GDM组的孕妇比Non-GDM组的年龄更大(29.9岁vs 28.9岁)、体质量指数(BMI)更高(22.2 kg/m^(2) vs 20.8 kg/m^(2)),差异有统计学意义(P<0.05)。GDM组的妊娠期高血压疾病(HDCP)的发生率高于Non-GDM组,差异有统计学意义(10.9%vs 4.6%,P<0.05)。两组其他围产期结局差异无统计学意义(P>0.05)。总计257例双生子从出生随访到12月龄,包括GDM组85例和Non-GDM组172例。随访期间GDM组双生子超重发生比率与Non-GDM组比较,差异无统计学意义(P>0.05);在纠正月龄3月和6月后,GDM组双生子肥胖发生比率明显高于Non-GDM组(P<0.05)。结论:双胎妊娠孕妇GDM的HDCP发生率较高,其双生子半岁内肥胖的发生率也较高,其他的母婴围产期结局无显著差异。

Objective:To evaluate the influence of gestational diabetes mellitus on perinatal outcomes and growth profiles from birth to 12 months in twins.Methods:A nested case-control study was conducted in 507 twin pregnancies.These women were categorized into GDM group and Non-GDM group according to their OGTT results.erinatal outcomes including pregnancy complications and growth profiles of twins from birth to 12 months were collected by follow up.Results:507 twin pregnancies were finally enrolled in the analysis.Women in GDM group had older age(median 29.9 vs.28.9,P<0.001)and higher body mass index(median 22.2 kg/m^(2) vs.20.8 kg/m^(2),P<0.05)than those in Non-GDM group.The incidence of hypertensive disorder complicating pregnancy(HDCP)in GDM group was also higher than Non-GDM group(10.9%vs.4.6%,P<0.05).The differences in other perinatal outcomes between the two groups were not statistically significant(P>0.05).There were 257 cases of twins had been followed-up for 12 months including 85 GDM cases and 172 Non-GDM cases.The incidence of overweight was not significantly different between the 2 groups during the one-year follow-up except for the corrected age of 3 month and 6 month.Conclusions:Compared to non-GDM,both the incidence of HDCP and obesity within half a year in their twin children were higher in twin pregnancies with GDM,with no significant differences in other maternal and infant perinatal outcomes.