双绒毛膜双胎新生儿低血糖的影响因素

Factors influencing neonatal hypoglycemia in dichorionic twins

目的探讨双绒毛膜双胎发生新生儿低血糖的影响因素。方法回顾性收集2022年1月1日至2023年12月31日在北京大学第一医院分娩的304例双绒毛膜双胎孕妇及其新生儿的临床资料,根据是否发生新生儿低血糖分为新生儿低血糖组(53例)和对照组(251例),比较2组一般情况。同时根据双胎出生体重差异进行分析,以18%为阈值分为双胎出生体重差异≥18%组(56例孕妇和其分娩的112例新生儿)和双胎出生体重差异<18%组(248例孕妇和其分娩的496例新生儿),各组间数据比较采用t检验、Mann-WhitneyU检验、χ2检验或Fisher精确概率法。应用配对t检验分析在不同出生体重差异的双胎中,比较大胎儿与小胎儿的临床特征。应用Poisson回归分析孕妇临床特征与新生儿低血糖的关联。结果双胎出生体重差异<18%组和≥18%组中,小胎儿与大胎儿的新生儿低血糖发生率分别为13.7%(34/248)与13.3%(33/248)、8.9%(5/56)与7.1%(4/56),脐动脉血糖分别为3.1 mmol/L(2.7~3.6 mmol/L)与3.1 mmol/L(2.7~3.6 mmol/L)、3.3 mmol/L(2.8~4.3 mmol/L)与3.4 mmol/L(3.0~4.3 mmol/L),差异均无统计学意义(P值均>0.05)。Poisson回归分析结果显示,分娩孕周小、妊娠期高血糖、促胎肺成熟治疗是新生儿低血糖的危险因素[RR值(95%CI)分别为1.024(1.002~1.049)、1.707(1.051~2.782)及1.744(1.011~3.027),P值均<0.05]。结论无论出生体重差异如何,双胎中大胎儿与小胎儿的脐动脉血糖和生后低血糖的风险均无显著差别。早产、妊娠期高血糖和促胎肺成熟治疗与双绒毛膜双胎新生儿低血糖相关。

ObjectiveTo investigate the factors influencing neonatal hypoglycemia in dichorionic twins.MethodsClinical data of 304 dichorionic twin pregnancies and their neonates delivered at Peking University First Hospital from January 1,2022,to December 31,2023,were retrospectively collected.The cases were divided into a neonatal hypoglycemia group(n=53)and a control group(n=251)based on the occurrence of neonatal hypoglycemia.General conditions of the two groups were compared.Additionally,analysis was conducted based on the birth weight difference between the twins,with 18%as the threshold,dividing them into groups with birth weight differences≥18%(56 pregnant women and 112 newborns delivered)and<18%(248 pregnant women and 496 newborns delivered).Data comparisons between groups were performed using t-test,Mann-Whitney U test,Chi-square test,or Fisher's exact test.Paired t-test was used to compare the clinical features between the larger and smaller twins in different birth weight difference groups.Poisson regression analysis was applied to examine the association between maternal clinical characteristics and neonatal hypoglycemia.ResultsIn the groups with birth weight differences<18%and≥18%,the incidence of neonatal hypoglycemia in smaller and larger twins were 13.7%(34/248)and 13.3%(33/248),8.9%(5/56)and 7.1%(4/56),respectively.The umbilical cord blood glucose levels were 3.1 mmol/L(2.7-3.6 mmol/L)and 3.1 mmol/L(2.7-3.6 mmol/L),3.3 mmol/L(2.8-4.3 mmol/L)and 3.4 mmol/L(3.0-4.3 mmol/L),respectively,with no statistically significant differences(all P>0.05).Poisson regression analysis showed that young gestational age at delivery,hyperglycemia in pregnancy,and fetal lung maturation promotion were risk factors for neonatal hypoglycemia[RR values(95%CI)were 1.024(1.002-1.049),1.707(1.051-2.782),and 1.744(1.011-3.027),respectively,all P<0.05].ConclusionsRegardless of weight difference,there is no significant difference in umbilical cord blood glucose and the risk of postnatal hypoglycemia between larger and smaller twins.Preterm birth,hyperglycemia in pregnancy and corticosteroid-induced fetal lung maturation are associated with neonatal hypoglycemia in dichorionic twins.