Feng Zhoushan, Wu Xiaohong, Tong Xiaomei, He Zheng, Yang Chunxia, Shen Wei, Ding Yueqin, Liu Jin, Meng Qiong, Zhang Aiqin, Jiang Hong, Yan Wenkang, Qiu Jianwu, Wei Xian, Zhang Yayu, Lin Xiaobo, Liu Lijun, Jin Ya, Wei Youfen, Yang Xiufang, Wang Yitong, Cai Yangfan, Lin Xinzhu, Cui Qiliang
Department of Neonatology, Guangzhou Key Laboratory of Neonatal Intestinal Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Front Pediatr. 2025 Jan 17;12:1412975. doi: 10.3389/fped.2024.1412975. eCollection 2024.
While prepregnancy overweight or obesity is known to negatively impact maternal health, its effect on twin infants is not well understood. Therefore, we conducted a nationwide, multicenter retrospective study to investigate the association between maternal prepregnancy weight and health outcomes in twins.
This study collected data from 22 healthcare units across 12 regions in China between January 2018 and December 2020. To control for confounding factors, multiple logistic regression, propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and overlapping weighting models (OW) were applied to explore the effects of prepregnancy BMI on Apgar scores and other outcomes.
After screening, a total of 4,724 women with twin pregnancies and 9,448 newborns were included in the study. Compared to normal prepregnancy weight, prepregnancy overweight/obesity significantly increased the risk of gestational hypertension and gestational diabetes in mothers [adjusted OR (95% CI): 1.85 (1.55-2.21) and 1.49 (1.27-1.74), respectively]. It also increased the incidence of twins with a 1-min Apgar score ≤7, whether they were larger or smaller [1.60 (1.20-2.13) and 1.45 (1.09-1.92), respectively]. Sensitivity analyses using PSM [1.60 (1.20-2.13) and 1.55 (1.07-2.25)], IPTW [1.67 (1.31-2.12) and 1.48 (1.17-1.87)], and OW [1.65 (1.08-2.57) and 1.47 (0.97-2.25)] confirmed the stability of these results. However, it did not affect the likelihood of a 5-min Apgar score ≤7 [adjusted OR (95% CI): 0.82 (0.24-2.17) and 1.40 (0.70-2.73)]. In contrast, prepregnancy underweight was associated with a reduced incidence of twins with a 1-min Apgar score ≤7 [adjusted OR (95% CI): 0.56 (0.32-0.92) and 0.58 (0.34-0.94)], but had no effect on the 5-min Apgar score ≤7 [adjusted OR (95% CI): 0.82 (0.24-2.17) and 0.22 (0.01-1.08)]. Prepregnancy BMI did not significantly affect twin birth weight discordance, NICU admission, preterm birth, or low birth weight.
Maternal overweight/obesity before pregnancy increases the risk of hypertensive disorders and gestational diabetes in twin pregnancies and significantly raises the likelihood of twins having a low 1-min Apgar score. However, no significant impact on 5-min Apgar scores was observed. These findings highlight the importance of managing weight before pregnancy and ensuring readiness for neonatal resuscitation during delivery.
虽然已知孕前超重或肥胖会对孕产妇健康产生负面影响，但其对双胎婴儿的影响尚不清楚。因此，我们开展了一项全国性、多中心回顾性研究，以调查孕产妇孕前体重与双胎健康结局之间的关联。
本研究收集了2018年1月至2020年12月期间中国12个地区22个医疗机构的数据。为控制混杂因素，应用多因素logistic回归、倾向得分匹配（PSM）、逆概率处理加权（IPTW）和重叠加权模型（OW）来探讨孕前BMI对阿氏评分及其他结局的影响。
经过筛选，本研究共纳入4724例双胎妊娠妇女及9448例新生儿。与孕前体重正常相比，孕前超重/肥胖显著增加了母亲患妊娠期高血压和妊娠期糖尿病的风险[校正OR（95%CI）：分别为1.85（1.55 - 2.21）和1.49（1.27 - 1.74）]。这也增加了1分钟阿氏评分≤7分的双胎发生率，无论其为较大胎儿还是较小胎儿[分别为1.60（1.20 - 2.13）和1.45（1.09 - 1.92）]。使用PSM[1.60（1.20 - 2.13）和1.55（1.07 - 2.25）]、IPTW[1.67（1.31 - 2.12）和1.48（1.17 - 1.87）]和OW[1.65（1.08 - 2.57）和1.47（0.97 - 2.25）]进行的敏感性分析证实了这些结果的稳定性。然而，这并未影响5分钟阿氏评分≤7分的可能性[校正OR（95%CI）：0.82（0.24 - 2.17）和1.40（0.70 - 2.73）]。相比之下，孕前体重过轻与1分钟阿氏评分≤7分的双胎发生率降低相关[校正OR（95%CI）：0.56（0.32 - 0.92）和0.58（0.34 - 0.94）]，但对5分钟阿氏评分≤7分无影响[校正OR（95%CI）：0.82（0.24 - 2.17）和0.22（0.01 - 1.08）]。孕前BMI对双胎出生体重差异、新生儿重症监护病房（NICU）入院、早产或低出生体重无显著影响。
孕前母亲超重/肥胖会增加双胎妊娠中高血压疾病和妊娠期糖尿病的风险，并显著提高双胎1分钟阿氏评分低的可能性。然而，未观察到对5分钟阿氏评分有显著影响。这些发现凸显了孕前体重管理以及分娩时确保做好新生儿复苏准备的重要性。
