双绒双羊双胎妊娠适宜增重范围的探究及其与围产结局的关系

Assessment of the recommended gestational weight gain range in dichorionic diamniotic twin pregnancies and its association with perinatal outcomes

摘要

目的 探讨双绒毛膜双羊膜囊(双绒双羊)双胎妊娠孕妇孕期体重增长的适宜范围及其与围产结局的关系。方法 选取2017年1月至2024年7月于广西壮族自治区妇幼保健院分娩的495例出生体重≥2500g的双绒双羊双胎者作为研究对象。首先按孕前体质指数(BMI)分为低体重组、正常体重组、超重组和肥胖组,计算标准化孕期增重的各百分位数,并将P₂₅~P₇₅作为孕期适宜增重推荐范围。其次按研究所得的适宜增重推荐范围将研究对象重新分为增重不足组、增重适宜组、增重过度组,分析孕期增重与围产结局的关系。结果 本研究低体重组(51例)、正常体重组(323例)、超重组(101例)和肥胖组(20例)孕期增重适宜范围[M(P₂₅~P₇₅)]分别为19.0(16.6~21.4)kg、18.0(15.0~20.6)kg、15.8(12.7~18.8)kg和14.7(11.7~19.9)kg。随着孕前BMI增加,双胎孕妇孕期增重总体上越少(H=23.643,P<0.001)。按照上述推荐范围重新分组后,增重不足组124例,增重适宜组244例,增重过度组127例。与增重不足组及增重适宜组相比,增重过度组妊娠期糖尿病发生率较低,妊娠期高血压发生率较高,差异有统计学意义(χ²值分别为12.849、7.421,P<0.05)。与增重适宜组和增重过度组相比,增重不足组新生儿出生体重较低,小于胎龄儿比例较高(F/χ²值分别为3.472、8.228,P<0.05);与增重过度组相比,增重不足组和增重适宜组新生儿黄疸发生率均较高(χ²=7.535,P<0.05)。结论 不同孕前BMI的双胎孕妇,其孕期增重范围不同,孕前BMI越高,孕期适宜增重越少,超过该范围可增加妊娠期高血压风险,而未达到该范围则会增加小于胎龄儿风险。临床上应更加关注双胎妊娠的孕期体重管理,以改善妊娠结局,促进母婴健康。

Abstract

Objective To investigate the appropriate range of gestational weight gain in pregnant women with dichorionic diamniotic (DCDA) twin pregnancies and its relationship with perinatal outcomes. Methods A total of 495 women with DCDA twin pregnancies delivering infants with birth weights ≥2500g between January 2017 and July 2024 at the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region were enrolled. Firstly, according to the pre-pregnancy body mass index (BMI), it was divided into low body weight group, normal weight group, over-recombinant and obese group, and the percentiles of standardized pregnancy weight gain were calculated, and P25-P75 was used as the recommended range for weight gain during pregnancy. Secondly, according to the recommended range of appropriate weight gain, the research subjects were re-divided into underweight gain group, appropriate weight gain group, and excessive weight gain group, and the relationship between pregnancy weight gain and perinatal outcomes was analyzed. Results In this study, the appropriate range of pregnancy weight gain [M (P25-P75)] in the low weight group (51 cases), normal weight group (323 cases), over-recombinant (101 cases) and obese group (20 cases) was 19.0 (16.6-21.4) kg, 18.0 (15.0-20.6) kg, 15.8 (12.7-18.8) kg and 14.7 (11.7-19.9) kg, respectively. With the increase of pre-pregnancy BMI, the overall weight gain of twin pregnant women was less during pregnancy (H=23.643, P<0.001). After regrouping according to the above recommended range, there were 124 cases in the insufficient weight gain group, 244 cases in the appropriate weight gain group, and 127 cases in the excessive weight gain group. Compared with the underweight gain group and the appropriate weight gain group, the incidence of gestational diabetes mellitus and gestational hypertension was higher in the overweight gain group (χ² values were 12.849 and 7.421, P<0.05, respectively). Compared with the appropriate weight gain group and the excessive weight gain group, the birth weight of newborns in the underweight gain group was lower and the proportion of newborns smaller than gestational age was higher (F/χ² values were 3.472 and 8.228, P<0.05, respectively). Compared with the excessive weight gain group, the incidence of neonatal jaundice in the underweight gain group and the appropriate weight gain group was higher (χ²=7.535, P<0.05). Conclusion The higher the pre-pregnancy BMI, the less weight gain is suitable during pregnancy, and the higher the pre-pregnancy BMI, the less weight gain is suitable during pregnancy. Clinically, more attention should be paid to the gestational weight management of twin pregnancies to improve pregnancy outcomes and promote maternal and infant health.

关键词

双胎妊娠 / 孕期增重 / 适宜范围 / 围产结局

Key words

twin pregnancies / weight gain during pregnancy / applicable range / perinatal outcome

参考文献

[1] 孔北华, 马丁, 段涛 主编． 妇产科学[M]．第10版． 北京: 人民卫生出版社, 2024: 64-151．

[2] 中华人民共和国国家卫生健康委员会 ． 妊娠期糖尿病妇女体重增长推荐值标准[J]． 全科医学临床与教育, 2024, 22(1): 5-6．

[3] Liang F, Lin Y, Li L, et al． Associations between gestational weight gain and adverse neonatal outcomes: a comparison between the US and the Chinese guidelines in Chinese women with twin pregnancies[J]． BMC Public Health, 2023, 23(1): 134．

[4] 耿小妍, 郑薇, 王腾, 等 ． 双胎妊娠孕期增重与围产结局的关系及适宜值探讨[J]． 中华围产医学杂志, 2019, 22(3): 150-156．

[5] 程子怡, 吴天晨, 盛晴, 等 ． 双绒毛膜双胎妊娠孕期体重增长特征的探索性研究[J]． 中华围产医学杂志, 2021, 24(7): 545-550．

[6] Whitaker K M, Ryan R, Becker C, et al． Gestational weight gain in twin pregnancies and maternal and child health: an updated systematic review[J]． J Womens Health (Larchmont), 2022, 31(3): 362-381．

[7] Sun Y, Shen Z, Zhan Y, et al． Effects of pre-pregnancy body mass index and gestational weight gain on maternal and infant complications[J]． BMC Pregnancy Childb, 2020, 20(1): 390．

[8] Lin D, Fan D, Wu S, et al． The effect of gestational weight gain on perinatal outcomes among Chinese twin gestations based on Institute of Medicine guidelines[J]． BMC Pregnancy Childb, 2019, 19(1): 262．

[9] 潘剑芳, 王小红 ． 孕期增重对双胎妊娠母婴结局的影响[J]． 中国妇幼健康研究, 2020, 31(4): 461-463．

[10] Lipworth H, Barrett J F, Murphy K E, et al． Gestational weight gain in twin gestations and pregnancy outcomes: a systematic review and meta-analysis[J]． BJOG, 2021, 128(13): 2098-2108．

[11] Zhong W, Fan X, Hu F, et al． Gestational weight gain and its effects on maternal and neonatal outcome in women with twin pregnancies: a systematic review and meta-analysis[J]． Front Pediatr, 2021, 9(1): 674414．

[12] 莫训群, 乐江华, 黄芯, 等 ． 双胎妊娠孕期体质量增长与妊娠结局关系的研究[J]． 实用妇产科杂志, 2022, 38(9): 694-698．

基金资助

广西医药卫生自筹科研课题(Z20200392)