双胎妊娠孕期体质量增长与妊娠结局关系的研究

Study on the Relationship between Body Weight Gain during Pregnancy and Pregnancy Outcome in Twin Pregnancy

目的:探讨孕前不同体质量指数(BMI)的双胎孕妇孕期体质量增长的适宜值,及其与妊娠结局的关系。方法:回顾性分析2018年1月至2020年12月在桂林医学院附属医院产科住院分娩的313例双胎孕妇,按照中国肥胖问题研究专题组提出的判断标准,按孕前BMI将调查对象划分为4组:<18.5 kg/m^(2)为低体质量组(10例),18.5~24.0 kg/m^(2)为正常体质量组(192例),24.0~28.0 kg/m^(2)为超重组(93例),≥28.0 kg/m^(2)为肥胖组(18例)。按照IOM推荐的双胎足月孕期增重范围,分为增重不足组(120例)、增重适宜组(153例)和增重过多组(40例),研究孕期增重与母体并发症及新生儿出生结局的关系。选择孕周≥37周且活产双胎新生儿平均出生体质量≥2500 g的孕妇共计131例,计算不同BMI双胎孕妇孕期增重的P_(25)~P_(75),确定孕期体质量增长的适宜范围。采用χ^(2)检验和多因素Logistic回归分析方法对数据进行统计学分析。结果:①与孕前正常体质量组相比,孕前超重组及肥胖组均减少了新生儿平均出生体质量<2500 g的风险[超重组(OR 0.551,95%CI 0.334~0.909),肥胖组(OR 0.321,95%CI 0.115~0.891)],孕前超重组出现新生儿窒息的风险减少(OR 0.353,95%CI 0.151~0.826),但孕前肥胖可增加妊娠期糖尿病(OR 3.914,95%CI 1.443~10.618)及子痫前期(OR 5.147,95%CI 1.715~15.451)的风险,差异均有统计学意义(P<0.05)。②与孕期增重适宜组相比,孕期增重不足增加早产(OR 3.297,95%CI 2.000~5.433)和至少有1个为小于胎龄儿(OR 2.732,95%CI 1.648~4.530)及新生儿平均出生体质量<2500 g (OR 3.922,95%CI 2.319~6.635)的风险,但是可降低剖宫产风险(OR 0.407,95%CI 0.217~0.765);与孕期增重适宜组相比,孕期增重过多则增加妊娠期糖尿病(OR 2.558,95%CI 1.254~5.219)及子痫前期(OR 3.429,95%CI 1.475~7.970)的风险,差异有统计学意义(P<0.05)。③孕周≥37周分娩,且新生儿平均出生体质量≥2500 g的131例孕妇,孕期总增重P_(25)~P_(75)范围分别为:孕前低体质量为15.50~18.75 kg,正常体质量为12.00~20.00 kg,超重为10.75~19.50 kg,肥胖为10.00~16.50 kg,均低于IOM推荐范围。结论:双胎妊娠孕妇孕期体质量增长与其母婴结局密切相关,应对双胎妊娠孕妇孕期体质量管理加以指导,降低不良妊娠结局的发生风险。

Objective:To explore the appropriate value of pregnancy weight gain in twin pregnant women with different body mass index(BMI)before pregnancy,and its relationship with pregnancy outcome.Methods:A retrospective cohort study was conducted in 313 twin pregnancy women who delivered from January 2018 to December 2020 in Affiliated Hospital of Guilin Medical University.According to the criteria proposed by the Chinese Obesity Research Topic Group,the subjects were divided into four groups by pre pregnancy BMI:under weight group(n=10,BMI<18.5 kg/m^(2)),normal weight group(n=192,BMI 18.5-24.0 kg/m^(2)),overweight group(n=93,BMI 24.0-28.0 kg/m^(2))and obese group(n=18,BMI≥28.0 kg/m^(2)).Only 131 women who delivered twins with an average birth weight of≥2500 g on≥37 gestational weeks were included when exploring the optimal gestational weight gain(GWG).P_(25)-P_(75)of weight gain during pregnancy of twin pregnant women with different pre-pregnancy BMI were calculated and determined as the appropriate range of body weight gain during pregnancy(GWG).They were divided into inadequate GWG group(n=120),appropriate GWG group(n=153)and excessive GWG group(n=40).The relationship between weight gain during pregnancy and maternal complications and neonatal birth outcome were studied.Chi-square test and multivariate Logistic regression analysis were used for statistical analysis.Results:①Compared with the pre-pregnancy normal body mass group,both the pre-pregnancy overweight and obese groups reduced the risk of average birth mass<2500 g[pre-pregnancy overweight group(OR 0.551,95%CI 0.334-0.909),pre-pregnancy obese group(OR 0.321,95%CI 0.115-0.891)].The risk of neonatal asphyxia was reduced in pre-pregnancy overweight group(OR 0.353,95%CI 0.151-0.826).However,pre-pregnancy obesity increased the risk of gestational diabetes mellitus(OR 3.914,95%CI 1.443-10.618)and pre-eclampsia(OR 5.147,95%CI 1.715-15.451).The difference was statistically significant(P<0.05).②Compared with the women with appropriate GWG,the risks of preterm delivery(OR 3.297,95%CI 2.000-5.433),at least one small for gestation age infant(OR 2.732,95%CI 1.648-4.530)and the average birth weight less than 2500 g(OR 3.922,95%CI 2.319-6.635)increased in inadequate GWG group.However appropriate GWG reduced the rate of the cesarean section(OR 0.407,95%CI 0.217-0.765).Compared with the women with appropriate GWG,the risk of gestation diabetes mellifluous(OR 2.558,95%CI 1.254-5.219)and preeclampsia increased(OR 3.429,95%CI 1.475-7.970)in excessive GWG women.The difference was statistically significant(P<0.05).③In 131 pregnant women who delivered at≥37 weeks of pregnancy and with the average birth mass≥2500 g,the total GWG reference values(P_(25)-P_(75))for twin pregnancies at term were 15.50-18.75 kg for under weight women,12.00-20.00 kg for normal weight women,10.75-19.50 kg for overweight women and 10.00-16.50 kg for obese women.Conclusions:Gestational weight gain of twin pregnant women is closely related to maternal and fetal outcomes.The post-pregnancy weight management of twin pregnancies should be guided to reduce the risk of adverse pregnancy outcomes.