双胎妊娠胎儿不同孕周的适宜体重与妊娠并发症和妊娠结局的探讨

Exploration on appropriate fetal weight of twin pregnancies at different gestational weeks and pregnancy complications and outcomes

目的探讨双胎妊娠胎儿不同孕周的适宜体重及其妊娠并发症和妊娠结局。方法回顾性分析2004年1月至2020年12月在北京大学第一医院分娩的1225例双胎妊娠孕妇不同孕周的胎儿体重及相关的妊娠并发症和妊娠结局,包括妊娠期高血压疾病、妊娠期糖尿病(GDM)、胎儿生长受限(FGR)、胎儿窘迫、早产及新生儿窒息。双胎妊娠胎儿不同孕周的适宜体重使用616例无妊娠并发症(除早产)双胎妊娠孕妇的1232例新生儿出生体重进行分析,以第10~90百分位数表示,并比较小于胎龄儿(SGA)、大于胎龄儿(LGA)与适于胎龄儿(AGA)双胎妊娠的妊娠并发症及不良妊娠结局的发生风险,以及不同年份间妊娠并发症及不良妊娠结局发生率的变化。结果双胎妊娠不同孕周新生儿适宜体重分别为孕28周910~1255 g、孕29周996~1518 g、孕30周1105~1785 g、孕31周1295~1825 g、孕32周1336~2000 g、孕33周1754~2321 g、孕34周1842~2591 g、孕35周1913~2615 g、孕36周2150~2847 g、孕37周2350~3130 g及孕38~40周2450~3250 g。SGA双胎妊娠孕妇的妊娠期高血压疾病、FGR、胎儿窘迫及新生儿窒息比例均高于AGA双胎妊娠孕妇,分别比较,差异均有统计学意义(P均<0.05)。2017—2020年间双胎妊娠孕妇GDM的发生率比2004—2009、2010—2016年间均增高,但胎儿窘迫及新生儿窒息的发生率均低于2010—2016年间,分别比较,差异均有统计学意义(P均<0.05)。结论双胎妊娠胎儿不同孕周的适宜体重不同于单胎。在本研究所得的双胎妊娠胎儿适宜体重标准下,AGA双胎妊娠并发症及不良妊娠结局发生率显著低于SGA,可为临床双胎妊娠的孕期管理提供一定的实践依据。

Objective To explore the appropriate fetal weight of twin pregnancies at different gestational weeks and the association with pregnancy complications and outcomes.Methods Fetal weight at different gestational weeks and related pregnancy complications and outcomes from 1225 twin pregnancies,who gave birth at Peking University First Hospital from January 2004 to December 2020,were analyzed in this study,including hypertensive disorders in pregnancy,gestational diabetes mellitus(GDM),fetal growth restriction(FGR),fetal distress,preterm birth and neonatal asphyxia.The appropriate fetal weight of twin pregnancies at different gestational weeks were analysed based on the information from 616 twin pregnancies without complications(except preterm birth),and were expressed as P10~P90.The chi-square test was used to compare the risk of pregnancy complications and adverse outcomes in large for gestational age(LGA),appropriate for gestational age(AGA)and small for gestational age(SGA)twin pregnancies and the difference in incidence of pregnancy complications and adverse outcomes in different years.Results The appropriate fetal weights of normal twin pregnancies at 28 to 37 weeks and 38-40 weeks of gestation were 910-1255 g,996-1518 g,1105-1785 g,1295-1825 g,1336-2000 g,1754-2321 g,1842-2591 g,1913-2615 g,2150-2847 g,2350-3130 g and 2450-3250 g,respectively.The incidences of hypertensive disorders in pregnancy,FGR,fetal distress and neonatal asphyxia related to SGA twin pregnancies were significantly higher than AGA twin pregnancies(all P<0.05).The incidence of GDM in twin pregnant from 2017 to 2020 was higher than that from 2004 to 2009 or from 2010 to 2016,but the incidence of fetal distress and neonatal asphyxia were lower than those from 2010 to 2016,and the differences were statistically significant(all P<0.05).Conclusions The appropriate weights of twin fetuses at different gestational weeks are different from singleton.The incidence of pregnancy complications and adverse outcomes in AGA fetuses is significantly lower than that in SGA fetuses under the specific weight standard for twin fetuses,which could provide a practical basis for clinical management of twin pregnancy.