双胎妊娠合并妊娠期糖尿病危险因素和妊娠结局分析

Analysis of risk factors and perinatal outcomes of twin pregnancies complicated with gestational diabetes mellitus

目的探讨双胎妊娠合并妊娠期糖尿病(gestational diabetes mellitus,GDM)发病的危险因素及对母婴妊娠结局的影响。方法回顾性分析2021年1月至2022年12月在武汉大学人民医院住院分娩的383例双胎妊娠孕妇的临床资料,其中GDM组(研究组)82例和糖耐量正常组(对照组)301例。分析两组一般临床特征、母婴妊娠结局和GDM发病危险因素。结果与对照组相比,研究组高龄41.5%(34/82)、孕前超重/肥胖35.4%(29/82)、多囊卵巢综合征(PCOS)病史13.4%(11/82)、辅助生殖技术受孕75.6%(62/82)均高于对照组[分别为17.9%(54/301)、19.9%(60/301)、6.3%(19/301)、59.1%(178/301)](P<0.05);研究组胎膜早破发生率15.9%(13/82)、产后出血3.7%(3/82)、妊娠期高血压7.3%(6/82)、子痫前期20.7%(17/82)、妊娠期肝内胆汁淤积症17.1%(14/82)均高于对照组[分别为3.3%(10/301)、0.7%(2/301)、0.7%(2/301)、1.0%(3/301)、2.7%(8/301)](P<0.05);研究组平均新生儿出生体重[(2385.5±504.4)g]和任一大于胎龄儿(LGA)发生率30.5%(25/82)高于对照组[分别为(2278.8±535.4)g、17.9%(54/301)](P<0.05)。高龄(P=0.022)、妊娠前体质指数(BMI)(P=0.008)、辅助生殖受孕(P=0.009)、PCOS病史(P=0.032)和妊娠期体重增长(P=0.001)均为双胎妊娠合并GDM的独立危险因素。结论双胎妊娠合并GDM增加子痫前期、妊娠期高血压、产后出血等不良妊娠结局发生,但对新生儿结局影响有限;高龄、妊娠前BMI、辅助生殖受孕、PCOS病史及妊娠期体重增长均会增加双胎妊娠合并GDM的风险。

Objective To investigate the risk factors and perinatal outcomes of twin pregnancies complicated with GDM.Methods A retrospective analysis was conducted on the clinical data of 383 twin pregnant women who delivered at Wuhan University People's Hospital from January 2021 to December 2022,including 82 cases in the GDM group(the research group)and 301 cases in the group with normal glucose tolerance(the control group)The general clinical characteristics,perinatal outcomes of the two groups and the risk factors of GDM were analyzed.Results Compared with the control group,the ratios of advanced pregnancy 41.5%,overweight/obesity before pregnancy 35.4%,history of PCOS 13.4%,assisted reproductive technology 75.6%were higher in the study group[(Respectively:17.9%,19.9%,6.3%,59.1%)(178/301)](P<0.05);The incidences of premature rupture of membranes 15.9%,postpartum hemorrhage 3.7%,gestational hypertension 7.3%,preeclampsia 20.7%,intrahepatic cholestasis of pregnancy 17.1%in the study group were higher(Respectively:3.3%,0.7%,0.7%,1.0%,2.7%)(P<0.05);The average birth weight[(2385.5±504.4)g],the incidence of LGA in any neonates 30.5%in the study group were higher[Respectively:(2278.8±535.4)g,17.9%(54/301)](P<0.05).Advanced age(P=0.022),pre-pregnancy BMI(P=0.008),assisted reproductive conception(P=0.009),PCOS history(P=0.032)and weight gain(P=0.001)during pregnancy were independent risk factors for twin pregnancies complicated with GDM.Conclusions Twin pregnancies complicated with GDM increase the incidence of preeclampsia,gestational hypertension,postpartum hemorrhage and other adverse maternal outcomes,but there are limited impacts on neonatal outcomes.Advanced age,pre-pregnancy BMI,assisted reproductive technology and PCOS history increase the risk of GDM.