Mendez-Figueroa Hector, Truong Van Thi Thanh, Pedroza Claudia, Chauhan Suneet P
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
Department of Pediatrics, Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas.
Am J Perinatol. 2018 Jan;35(2):184-191. doi: 10.1055/s-0037-1606381. Epub 2017 Sep 5.
We hypothesized that utilization of a twin-specific nomograms, when compared with one based on singleton data, is less likely to classify twins as having abnormal growth and more likely to identify perinatal morbidity and mortality.
Data were culled from seven Maternal-Fetal Medicine Units (MFMU) studies, the included twin gestations in their study population. Each newborn twin's birth weight percentile was categorized using Alexander et al (singleton data) and Ananth et al (twin data) nomogram. Logistic regression models were adjusted for maternal race and body mass index, neonatal sex, study, and twin correlation.
More twins were categorized as small for gestational age (SGA) when singleton nomogram was used (33%) compared with twin nomogram (4%). The use of singleton nomogram revealed a higher composite neonatal morbidity (CNM) and stillbirth rates among SGA twins but a similar neonatal mortality rate when compared with appropriate for gestational age. Correspondingly, when twin-specific nomogram was utilized, the CNM, odds of stillbirth, and neonatal mortality were higher among SGA twins. The rate of large for gestational age among twins was increased with the use of twin-specific nomograms.
Utilization of twin-specific nomogram is less likely to categorize twins as SGA and more likely to identify those at risk for stillbirth and neonatal mortality.
我们假设，与基于单胎数据的列线图相比，使用双胎特异性列线图将双胎归类为生长异常的可能性较小，而识别围产期发病率和死亡率的可能性较大。
数据取自七项母胎医学单位（MFMU）研究，纳入其研究人群中的双胎妊娠。使用亚历山大等人（单胎数据）和阿南特等人（双胎数据）的列线图对每个双胎新生儿的出生体重百分位数进行分类。逻辑回归模型针对母亲种族和体重指数、新生儿性别、研究以及双胎相关性进行了调整。
与双胎列线图（4%）相比，使用单胎列线图时更多双胎被归类为小于胎龄儿（SGA）（33%）。使用单胎列线图显示，SGA双胎的综合新生儿发病率（CNM）和死产率较高，但与适于胎龄儿相比，新生儿死亡率相似。相应地，当使用双胎特异性列线图时，SGA双胎的CNM、死产几率和新生儿死亡率较高。使用双胎特异性列线图时，双胎中大于胎龄儿的发生率增加。
使用双胎特异性列线图将双胎归类为SGA的可能性较小，而识别死产和新生儿死亡风险双胎的可能性较大。
