双胎妊娠合并妊娠期糖尿病的围产结局及相关危险因素分析

Analysis of perinatal outcomes and related risk factors of gestational diabetes mellitus in twin pregnancies

目的探讨双胎妊娠合并妊娠期糖尿病(GDM)的围产结局,并分析双胎GDM发病的相关危险因素。方法回顾性分析2015年1月至2020年6月在中山大学附属第三医院住院分娩的双胎妊娠孕妇757例,根据75 g口服葡萄糖耐量试验(OGTT)结果,分为双胎GDM组196例,正常双胎组(双胎未合并GDM)561例。收集各组母儿的临床资料、围产结局和新生儿结局,并采用t检验、Mann-Whitney U检验、χ^(2)检验或Fisher确切概率法比较,采用多因素logistic逐步回归分析评价双胎GDM发病的相关危险因素。结果双胎GDM组的75 g OGTT FPG、1 h血糖和2 h血糖均大于正常双胎组;双胎GDM组的分娩孕周、新生儿出生体重小于正常双胎组,<37周的早产率大于正常双胎组;双胎GDM组的新生儿呼吸窘迫综合征(RDS)、感染及贫血发生率大于正常双胎组,差异均具有统计学意义(均P<0.05)。两组相比,年龄、孕前体重指数(Pre-BMI)、孕次、产次、体外受精-胚胎移植(IVF-ET)占比、绒毛膜性质、多囊卵巢综合征(PCOS)病史及糖尿病家族史差异均有统计学意义(均P<0.05),将以上因素进行多因素的logistic逐步回归分析,显示年龄≥35岁(OR值为2.335)、Pre-BMI≥24.0 kg/m^(2)(OR值为2.356)、PCOS病史(OR值为1.932)、糖尿病家族史(OR值为3.127)是双胎GDM发病的独立危险因素(均P<0.05)。结论双胎GDM增加了<37周的早产、新生儿RDS、感染及贫血发生率;年龄≥35岁、Pre-BMI≥24.0 kg/m^(2)、PCOS病史和糖尿病家族史是双胎GDM发病的独立危险因素。

Objective To explore the effects of gestational diabetes mellitus(GDM)on the perinatal outcomes in twin pregnancies,and analyze the risk factors of twin pregnancies complicated with GDM.Methods Retrospective analysis was performed on 757 patients of twin pregnancies who had delivered in the Third Affiliated Hospital of Sun Yat-sen University during January 2015 to June 2020.According to the results of 75 g oral glucose tolerance test(OGTT),196 cases were in the GDM group,and 561 cases were inthe non-GDM group.The clinical characteristics of the subjects were recorded,the perinatal outcomes of the two groups were compared by using t test,Mann-Whitney U test,χ^(2) test or Fisher exact probability method;the risk factors related to GDM were analyzed by multivariate-logistic stepwise regression.Results Compared with the non-GDM group,75 g OGTT-fasting plasma glucose(FPG),1 h plasma glucose(PG),2 h PG in GDM group were higher,gestational weeks and birth weight of newborn in GDM group were lower,the rate of preterm birth(<37 weeks)was higher.The incidence of neonatal respiratory distress syndrome,infection and anemia in the GDM group was higher than that in the non-GDM group(all P<0.05).There were statistically significant differences in age,pre-pregnancy body mess index(pre-BMI),gravidity,parity,proportion of in vitro fertilization and embryo transfer(IVF-ET),chorionicity,polycystic ovary syndrome(PCOS)history and family history of diabetes(all P<0.05).Risk factors were analyzed by multivariate-logistic stepwise regression,age≥35 years(OR=2.335),pre-BMI≥24.0 kg/m^(2)(OR=2.356),PCOS history(OR=1.932)and family history of diabetes(OR=3.127)were independent risk factors for GDM in twin pregnancies(all P<0.05).Conclusions GDM increased the incidence of preterm birth less than 37 weeks,neonatal respiratory distress syndrome,infection and anemia in twin pregnancies.Age≥35 years,pre-BMI≥24.0 kg/m^(2),PCOS history and family history of diabetes were independent risk factors for GDM in twin pregnancies.