Fox Nathan S, Stern Erica, Gupta Simi, Saltzman Daniel H, Klauser Chad K, Rebarber Andrei
Maternal Fetal Medicine Associates, PLLC, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.
Obstet Gynecol. 2015 Apr;125(4):870-875. doi: 10.1097/AOG.0000000000000741.
To evaluate whether a history of preterm birth or small for gestational age (SGA) in a singleton pregnancy is associated with an increased risk of recurrence of the same condition in a subsequent twin pregnancy.
Retrospective cohort study of twin pregnancies delivered in one maternal-fetal medicine practice from 2005 to 2014. Patients with a history of singleton preterm birth at less than 37 weeks of gestation were compared with patients with a history of singleton term birth and nulliparous patients. A similar analysis was performed for a history of SGA (birth weight less than 10%).
Six hundred forty-seven twin pregnancies were included. The prior singleton gestational age at delivery was significantly positively correlated with the twin gestational age at delivery (P<.001), and the prior singleton birth weight was significantly positively correlated with the birth weight of the larger twin (P<.001) and the smaller twin (P<.001). The rate of twin preterm birth before 32 weeks of gestation was 3.5% in patients with a prior term birth, 9.2% in nulliparous patients, and 26% in patients with a prior preterm birth (P<.001). The rate of SGA in patients with a prior birth not complicated by SGA was 42.1%, in nulliparous women it was 54.4%, and in patients with a history of SGA it was 65.2% (P=.007). On regression analysis, prior preterm birth and SGA of a singleton pregnancy were independently associated with recurrence of the same condition in a subsequent twin pregnancy.
Prior preterm birth and SGA in a singleton pregnancy increase the risk of the same condition in a subsequent twin pregnancy. We postulate that the extrinsic mechanism responsible for the pathophysiology of adverse outcomes in twin pregnancies overlaps with that in singleton pregnancies.
评估单胎妊娠中早产史或小于胎龄儿（SGA）史是否与随后双胎妊娠中相同情况复发风险增加相关。
对2005年至2014年在一家母胎医学机构分娩的双胎妊娠进行回顾性队列研究。将妊娠小于37周的单胎早产史患者与单胎足月产史患者及未生育患者进行比较。对SGA史（出生体重低于第10百分位数）进行了类似分析。
纳入647例双胎妊娠。既往单胎分娩时的孕周与双胎分娩时的孕周呈显著正相关（P<0.001），既往单胎出生体重与较大双胎儿的出生体重呈显著正相关（P<0.001），与较小双胎儿的出生体重也呈显著正相关（P<0.001）。既往足月产患者中孕32周前双胎早产率为3.5%，未生育患者为9.2%，既往有早产史患者为26%（P<0.001）。既往出生无SGA并发症患者的SGA发生率为42.1%，未生育女性为54.4%，有SGA史患者为65.2%（P=0.007）。回归分析显示，单胎妊娠既往早产和SGA与随后双胎妊娠中相同情况的复发独立相关。
单胎妊娠既往早产和SGA会增加随后双胎妊娠中相同情况的风险。我们推测，双胎妊娠不良结局病理生理的外在机制与单胎妊娠的外在机制重叠。
