Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).
Department of Obstetrics, Chongqing Women's and Children's Health Center, Chongqing, China (mainland).
Med Sci Monit. 2018 Nov 19;24:8342-8347. doi: 10.12659/MSM.911784.
BACKGROUND Excessive or insufficient gestational weight gain (GWG) is associated with increased risks of pregnancy complications and adverse delivery outcomes in dichorionic twin pregnancies. The provisional Institute of Medicine (IOM) 2009 guidelines suggested the optimal GWG based on limited epidemiological data collected from Western populations. However, such a recommendation has not yet been validated in a Chinese Han population, the world's largest ethnic group. The objective of this study was to assess the effect of IOM guidelines by determining the neonatal and maternal outcomes associated with gaining weight below, within, and above the IOM provisional guidelines on GWG in Chinese Han twin pregnancies. MATERIAL AND METHODS A historical cohort study of 350 twin-conceiving Han women in Chongqing Women and Children's Health Center delivering liveborn twin infants between January 2015 and November 2016 was conducted. The participants were divided into 3 groups according to the 2009 Institute of Medicine recommendations of GWG: a low GWG group, an adequate GWG group, and a high GWG group. The incidence of pregnancy complications and the delivery outcomes were compared between the groups, and the correlation of GWG and pregnancy complications or delivery outcome was investigated by logistic regression analysis. RESULTS In Han Chinese people, the gestational age (GA) at delivery was significantly different among various GWG groups, and low maternal GWG is associated with shorter GA. Although low GWG increased the incidence of VPTD, it did not impact PTD in twin pregnancies. Moreover, GWG was negatively correlated with the incidence of PPROM and was positively correlated with GHP development in twin pregnancies. CONCLUSIONS The recommendations of the 2009 IOM guidelines about GWG is beneficial in reducing the incidence of VPTD and PPROM in Han Chinese dichorionic twin pregnancies, but failed to eliminate the development of PTD, PROM, GDM, PE, ICP, and SGA.
在双绒毛膜性双胞胎妊娠中，过多或过少的妊娠期体重增加（GWG）与妊娠并发症和不良分娩结局的风险增加有关。临时医学研究所（IOM）2009 年指南根据从西方人群中收集的有限的流行病学数据，提出了最佳 GWG 建议。然而，这种建议尚未在中国汉族人群中得到验证，汉族是世界上最大的民族。本研究的目的是通过确定与 GWG 低于、等于和高于 IOM 临时指南相关的新生儿和产妇结局，评估 IOM 指南的效果。
对 2015 年 1 月至 2016 年 11 月在重庆妇幼保健院分娩的 350 名汉族双胎妊娠的历史队列研究进行了回顾性分析。根据 2009 年 IOM 关于 GWG 的建议，将参与者分为 3 组：低 GWG 组、适当 GWG 组和高 GWG 组。比较各组妊娠并发症发生率和分娩结局，并通过 logistic 回归分析探讨 GWG 与妊娠并发症或分娩结局的相关性。
在中国汉族人群中，不同 GWG 组之间的分娩孕周（GA）有显著差异，低母体 GWG 与 GA 缩短有关。虽然低 GWG 增加了 VPTD 的发生率，但对双胞胎妊娠的 PTD 没有影响。此外，GWG 与 PPROM 的发生率呈负相关，与双胞胎妊娠中 GHP 的发展呈正相关。
2009 年 IOM 指南关于 GWG 的建议有助于降低汉族双绒毛膜性双胞胎妊娠中 VPTD 和 PPROM 的发生率，但未能消除 PTD、PROM、GDM、PE、ICP 和 SGA 的发生。
