Tamai Kei, Yorifuji Takashi, Takeuchi Akihito, Nakamura Makoto, Washio Yosuke, Tsukahara Hirokazu, Doi Hiroyuki, Kageyama Misao
Department of Neonatology, Okayama Medical Center, National Hospital Organization, Okayama, Japan.
Department of Human Ecology, Okayama University Graduate School of Environmental and Life Science, Okayama, Japan.
Early Hum Dev. 2019 Jan;128:41-47. doi: 10.1016/j.earlhumdev.2018.11.005. Epub 2018 Nov 20.
The prevalence of multiple births has recently increased. However, the association between gestational age and long-term morbidity among twins remains unclear.
To examine the association of gestational age with child health and neurological development in early childhood among twins.
Population-based longitudinal study.
We included 947 children from 479 pairs of twins with information on gestational age.
Hospitalization was used as an indicator of physical health, and responses to questions about age-appropriate behaviors were used as an indicator of neurobehavioral development. We conducted binomial log-linear regression analyses, controlling for both child and maternal variables in the model. We accounted for correlations within the pairs with generalized estimating equations.
The early term group (i.e., 37 to 38 weeks of gestation) had a lower risk of poor child health and unfavorable neurodevelopment compared with the full term group (≥39 weeks of gestation) and preterm group (<37 weeks of gestation). Compared with the early term group, the adjusted risk ratios for hospitalization for all causes during the period from 7 to 18 months of age was 2.2 (95% confidence interval: 1.3-3.8) for very preterm children (<32 weeks of gestation), 1.1 (0.8-1.6) for moderately and late preterm children (32 to 36 weeks of gestation), and 1.8 (1.0-3.2) for full term children.
We observed a U-shaped association of gestational age with child health and neurodevelopment. The early term group had the lowest risk of poor outcomes among twins.
近年来多胞胎的患病率有所上升。然而，双胞胎的孕周与长期发病率之间的关联仍不明确。
研究双胞胎儿童健康和神经发育与孕周之间的关联。
基于人群的纵向研究。
我们纳入了来自479对双胞胎的947名儿童，这些儿童有孕周信息。
住院情况作为身体健康指标，对关于适龄行为问题的回答作为神经行为发育指标。我们进行了二项对数线性回归分析，在模型中控制儿童和母亲变量。我们使用广义估计方程考虑配对内的相关性。
与足月儿组（孕周≥39周）和早产儿组（孕周<37周）相比，近足月儿组（即孕周37至38周）儿童健康状况不佳和神经发育不良的风险较低。与近足月儿组相比，孕周<32周的极早产儿在7至18个月龄期间因各种原因住院的调整风险比为2.2（95%置信区间：1.3 - 3.8），孕周32至36周的中晚期早产儿为1.1（0.8 - 1.6），足月儿为1.8（1.0 - 3.2）。
我们观察到孕周与儿童健康和神经发育呈U形关联。近足月儿组在双胞胎中不良结局风险最低。
