中国双胎妊娠孕期体重变化轨迹与围产期结局的关联
Association between gestational weight change trajectories and perinatal outcomes in twin pregnancies in China.
作者信息
Li Mengmeng, Dawuti Wubulitalifu, Wu Tianchen, Tian Xiaoli, Zhang Yali, Gao Weixian, Huang Tao, Li Zhiwen
机构信息
Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, Peking University, National Health Commission of the People's Republic of China, Beijing, 100191, China.
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China.
出版信息
BMC Pregnancy Childbirth. 2025 Mar 19;25(1):312. doi: 10.1186/s12884-025-07414-5.
OBJECTIVE
This study aimed to identify gestational weight change trajectories and examine their association with perinatal outcomes.
METHODS
Prenatal and delivery records of 3393 twin pregnancies were obtained from the China-US Collaborative Project for Neural Tube Defects Prevention, a large population-based cohort study. Generalized gestational weight gain (GWG) was calculated by dividing the total GWG by the length of gestation in weeks and multiplying by 37 weeks. Latent class growth modeling (LCGM) was used to identify GWG patterns. Multivariable logistic regression and generalized estimating equations (GEE) were used to analyze the associations between GWG trajectories and perinatal outcomes. The included adverse perinatal outcomes were preterm birth, low birth weight (LBW), small for gestational age (SGA), and large for gestational age (LGA).
RESULTS
The mean ± SD of GWG for underweight women was 17.87 ± 5.67 kg, 16.76 ± 6.22 kg for normal weight, 14.34 ± 6.60 kg for overweight, and 14.27 ± 4.94 kg for obese. Three gestational weight change trajectory groups were identified: low-increase (32.36%), moderate-increase (56.26%), and high-increase (11.38%). Compared to the moderate-increase group, the high-increase group showed a reduced risk of LBW (aOR 0.68, 95%CI 0.56, 0.83), and SGA (aOR 0.49, 95%CI 0.40, 0.60) but an increased risk of LGA (aOR 2.23, 95%CI 1.48, 3.35). No significant change was observed in the risk of preterm birth in the high-increase group. The low-increase group had a higher risk of preterm birth (aOR 1.66 95%CI 1.42, 1.94), LBW (aOR 2.44 95%CI 2.13,2.80), and SGA (aOR 1.32 95%CI 1.16, 1.51), with no significant difference in the risk of LGA (aOR 1.11 95%CI 0.78,1.58).
CONCLUSIONS
Distinct patterns of GWG in twin pregnancies are associated with varying risks of adverse perinatal outcomes. These findings highlight the importance of monitoring and managing GWG in twin pregnancies.
目的
本研究旨在确定孕期体重变化轨迹，并探讨其与围产期结局的关联。
方法
从预防神经管缺陷的中美合作项目中获取了3393例双胎妊娠的产前和分娩记录，该项目是一项基于人群的大型队列研究。通过将孕期总增重除以孕周数，再乘以37周来计算广义孕期增重（GWG）。采用潜在类别增长模型（LCGM）来确定GWG模式。使用多变量逻辑回归和广义估计方程（GEE）分析GWG轨迹与围产期结局之间的关联。纳入的不良围产期结局包括早产、低出生体重（LBW）、小于胎龄儿（SGA）和大于胎龄儿（LGA）。
结果
体重过轻的女性GWG的均值±标准差为17.87±5.67kg，正常体重者为16.76±6.22kg，超重者为14.34±6.60kg，肥胖者为14.27±4.94kg。确定了三个孕期体重变化轨迹组：低增长组（32.36%）、中等增长组（56.26%）和高增长组（11.38%）。与中等增长组相比，高增长组LBW风险降低（调整后比值比[aOR]0.68，95%置信区间[CI]0.56，0.83），SGA风险降低（aOR0.49，95%CI0.40，0.60），但LGA风险增加（aOR2.23，95%CI1.48，3.35）。高增长组早产风险未观察到显著变化。低增长组早产风险较高（aOR1.66，95%CI1.42，1.94），LBW风险较高（aOR2.44，95%CI2.13，2.80），SGA风险较高（aOR1.32，95%CI1.16，1.51），LGA风险无显著差异（aOR1.11，95%CI0.78，1.58）。
结论
双胎妊娠中不同的GWG模式与不良围产期结局的不同风险相关。这些发现凸显了监测和管理双胎妊娠中GWG的重要性。
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