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根据绒毛膜性对双胎妊娠出生后 1 年的围产结局和神经发育的影响

Perinatal Outcomes and Neurodevelopment 1 Year after Birth in Discordant Twins According to Chorionicity.

机构信息

Department of Obstetrics and Gynecology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea.

High Risk Maternal Fetus Intensive Care Center, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea.

出版信息

Medicina (Kaunas). 2023 Mar 2;59(3):493. doi: 10.3390/medicina59030493.

Abstract

: This study aimed to compare maternal complications, perinatal outcomes, and neurodevelopment 1 year after the birth between concordant and discordant twins in monochorionic and dichorionic twins. : This retrospective study included twin pregnancies delivered between 24 + 1 and 38 + 2 weeks of gestation between January 2011 and September 2019. Chorionicity was confirmed by ultrasonography and was categorized into monochorionic and dichorionic. Each was then divided into two groups (concordant and discordant) according to birth weight discordancy. Maternal complications and neonatal outcomes, including neurodevelopmental delays, were compared between the two groups. : A total of 298 pairs of twin pregnancies were enrolled, of which 58 (19.26%) women were pregnant with monochorionic diamniotic twins and 240 (80.54%) with dichorionic diamniotic twins. In both monochorionic and dichorionic twins, the discordant twins had a greater incidence of emergency deliveries because of iatrogenic causes than the concordant twins. Among dichorionic twins, discordant twins had lower birth weight rates and higher hospitalization rates and morbidities than concordant twins. Among monochorionic twins, discordant twins had a lower birth weight and higher neonatal mortality than concordant twins. The neonatal size was not a predictor of neurodevelopment in this group. Based on the logistic regression analysis, male sex, respiratory distress syndrome, and bronchopulmonary dysplasia were risk factors for the neurodevelopmental delay; birth weight discordancy was significant only in dichorionic twins. : Perinatal outcomes in discordant twins may be poor, and neurodevelopment 1 year after birth was worse in discordant twins than in concordant twins. Discordancy in twins can be a risk factor for neurodevelopmental delay.

摘要

这项研究旨在比较单绒毛膜和双绒毛膜的同卵双胎和异卵双胎中,母亲并发症、围产儿结局和神经发育 1 年后的差异。

这是一项回顾性研究,纳入了 2011 年 1 月至 2019 年 9 月期间 24+1 周至 38+2 周分娩的双胎妊娠。通过超声检查确定绒毛膜性,并分为单绒毛膜和双绒毛膜。然后根据出生体重的差异将每一种进一步分为两组(同卵双胎和异卵双胎)。比较两组间的母亲并发症和新生儿结局,包括神经发育迟缓。

共纳入 298 对双胎妊娠,其中 58 例(19.26%)为单绒毛膜双羊膜囊双胎,240 例(80.54%)为双绒毛膜双羊膜囊双胎。在单绒毛膜和双绒毛膜双胎中,由于医源性原因,异卵双胎的紧急分娩发生率高于同卵双胎。在双绒毛膜双胎中,异卵双胎的出生体重较低,住院率和发病率较高,而在单绒毛膜双胎中,异卵双胎的出生体重较低,新生儿死亡率较高。新生儿体重不是该组神经发育的预测因素。基于逻辑回归分析,男性、呼吸窘迫综合征和支气管肺发育不良是神经发育迟缓的危险因素;出生体重差异仅在双绒毛膜双胎中是显著的。

异卵双胎的围产儿结局可能较差,神经发育 1 年后异卵双胎的发育较同卵双胎差。双胎的差异可能是神经发育迟缓的危险因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73c7/10054047/aa56c34fdf63/medicina-59-00493-g001.jpg

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