Inde Yusuke, Satomi Misao, Iwasaki Nao, Ono Shuichi, Yamashita Eriko, Igarashi Miwa, Hiraizumi Yoshie, Murata Tomoaki, Miyake Hidehiko, Suzuki Shunji
Department of Obstetrics and Gynaecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan.
J Obstet Gynaecol Res. 2011 Jan;37(1):24-31. doi: 10.1111/j.1447-0756.2010.01301.x. Epub 2010 Nov 18.
To investigate the maternal risk factors for small-for-gestational age (SGA) newborns in Japanese dichorionic (DC) twins.
A retrospective study was conducted from 2003 to 2008 on 340 DC twin pregnancies resulting in two live births. Newborns were classified as SGA if their birth weight was below the 10th percentile according to Japanese singleton norms. Statistical differences were evaluated between pregnancies resulting in appropriate-for-gestational age (AGA) pairs and those resulting in at least one SGA neonate.
The study population consisted of AGA/AGA (50.8%), AGA/SGA (37.0%) and SGA/SGA pairs (12.0%). Logistic regression analysis identified significant interrelations for SGA with maternal nulliparity (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.30-0.91), smoking (OR 3.25, 95% CI 1.09-9.66), assisted reproductive technology (OR 0.52, 95% CI 0.30-0.89), pregnancy-induced hypertension (OR 2.00, 95% CI 1.01-4.31), pregravid weight (kg) (unitary OR 0.94, 95% CI 0.91-0.97) and monthly weight gain (kg/month) (unitary OR 0.25, 95% CI 0.14-0.44). Bivariable receiver operating characteristic curves were generated for monthly weight gain (area under the curve [AUC] 0.626, cutoff 1.41 kg/month, P<0.001) and total weight gain (AUC 0.615, cutoff 14.0 kg, P<0.001).
Cigarette smoking and weight gain control are relatively modifiable factors for which interventional management is necessary to avoid perinatal problems arising from SGA pregnancy. Further studies are needed to investigate optimal nutrition, health guidance and subsequent weight gain control that lead to concrete improvement in maternal and infant prognoses.
探讨日本双绒毛膜（DC）双胎中小于胎龄儿（SGA）新生儿的母体危险因素。
对2003年至2008年期间340例DC双胎妊娠且分娩出两个活产儿的病例进行回顾性研究。根据日本单胎标准，出生体重低于第10百分位数的新生儿被归类为SGA。对分娩出适于胎龄（AGA）双胎的妊娠与至少分娩出一名SGA新生儿的妊娠之间的统计学差异进行评估。
研究人群包括AGA/AGA（50.8%）、AGA/SGA（37.0%）和SGA/SGA双胎（12.0%）。逻辑回归分析确定SGA与母体初产（比值比[OR]0.52，95%置信区间[CI]0.30 - 0.91）、吸烟（OR 3.25，95% CI 1.09 - 9.66）、辅助生殖技术（OR 0.52，95% CI 0.30 - 0.89）、妊娠期高血压（OR 2.00，95% CI 1.01 - 4.31）、孕前体重（kg）（单因素OR 0.94，95% CI 0.91 - 0.97）和每月体重增加（kg/月）（单因素OR 0.25，95% CI 0.14 - 0.44）之间存在显著相关性。针对每月体重增加（曲线下面积[AUC]0.626，截断值1.41 kg/月，P<0.001）和总体重增加（AUC 0.615，截断值14.0 kg，P<0.001）生成了双变量受试者工作特征曲线。
吸烟和体重增加控制是相对可改变的因素，为避免SGA妊娠引起的围产期问题，需要进行干预管理。需要进一步研究以探讨最佳营养、健康指导及后续体重增加控制措施，从而切实改善母婴预后。
