双胎体重不均衡临床病例分析

目的 探讨双胎体重不均衡与母亲妊娠期合并症及新生儿疾病的关系.方法 回顾性分析2010-2011年在我院分娩、并住我院新生儿重症监护病房治疗的双胎,双胎新生儿体重差≥20％为体重不均衡组,＜20％为体重均衡组,比较两组母亲合并症情况及两组新生儿结局.结果 共纳入74对双胎,其中体重不均衡组31对,占41.9％,母亲合并妊娠期高血压综合征、胎膜早破、妊娠期肝内胆汁淤积症、妊娠期糖尿病的比例均明显高于体重均衡组[41.9％比16.3％,32.2％比9.3％,35.5％比11.6％,25.8％比7.0％,P＜0.05].体重不均衡组新生儿窒息、肺炎、高胆红素血症、呼吸窘迫综合征、贫血、红细胞增多症、喂养不耐受的发生率均高于体重均衡组[16.1％比4.6％,19.4％比4.6％,12.9％比3.5％,17.7％比4.6％,17.7％比5.8％,14.5％比3.5％,19.4％比4.6％,P＜0.05].Logistic多元回归分析显示,母亲合并妊娠期高血压综合征、肝内胆汁淤积症、糖尿病,以及新生儿窒息、肺炎、高胆红素血症、呼吸窘迫综合征、贫血、喂养不耐受均与双胎体重不均衡有关.结论 母亲妊娠期合并症与双胎体重不均衡有关,而双胎体重不均衡可能为新生儿疾病的影响因素.     

试管婴儿双胎及自然受孕双胎临床分析

目的分析试管婴儿双胎与自然受孕双胎产妇和新生儿的临床结局。方法收集2010年1月至2014年4月106例试管婴儿双胎妊娠(试管组)与256例自然受孕双胎妊娠(对照组)的产妇年龄、妊娠周期、分娩方式、妊娠期合并症、新生儿体格发育、新生儿出生缺陷及新生儿围生期疾病等临床资料,并进行统计学比较分析。结果试管组产妇平均年龄(32±4岁)高于对照组(28±4岁,P0.05)。试管组产妇妊娠期高血压及妊娠期糖尿病发生率均显著高于对照组(均P0.05)。两组新生儿在体格发育、出生缺陷疾病发生率、围生期疾病发病率及病死率等方面比较差异均无统计学意义(均P0.05)。结论本研究显示试管婴儿双胎与自然受孕双胎围生期结局无明显差异;试管婴儿双胎妊娠的产妇在妊娠期需密切关注血压及血糖的波动情况。     

未足月胎儿胎膜早破后残余羊水指数对妊娠结局和新生儿的影响

目的探讨未足月胎儿胎膜早破(PPROM)后残余羊水指数(AFI)对妊娠结局和新生儿的影响。方法回顾性分析2005年2月—2012年12月收治的653例PPROM的临床资料,根据ROC曲线确定截断值,将其分为2组,AFI≤40 mm为A组(n=252),AFI40 mm为B组(n=401),比较两组的妊娠结局和新生儿预后。结果 A组孕妇破膜至分娩时间为(69.54±14.25)h,短于B组的(136.96±9.54)h,差异有统计学意义(P0.01);两组孕妇破膜时孕周、剖宫产率、母亲发热和胎盘早剥发生率的差异无统计学意义(P均0.05)。A组新生儿病死率为3.57%,高于B组的1.25%,差异有统计学意义(P0.05)。两组新生儿1分钟Apgar评分、出生体质量、性别、出生胎龄、新生儿窒息率、胎儿宫内窘迫率和围产期感染率的差异均无统计学意义(P0.05)。Logistic回归分析显示,AFI≤40 mm可使新生儿死亡(OR=2.314,P0.05)和新生儿窒息(OR=3.05,P0.05)的发生率增高;破膜时孕周也是新生儿死亡的危险因素(OR=1.785,P0.05)。结论 PPROM后AFI与多项母婴不良结局密切相关,可以将AFI≤40mm作为终止妊娠的指标,以减少不良妊娠的发生。     

254例双胎新生儿不良结局危险因素分析

目的：探讨双胎新生儿不良结局的危险因素,为提高双胎新生儿的存活及改善预后提供参考。方法：收集2005年1月至2009年12月入住我科的254例双胎新生儿临床资料进行回顾性分析,分析不良结局的危险因素。结果：254例双胎儿中,84例有不良结局（33.1％）,其中死亡10例（3.9％）。多因素分析结果显示通过辅助生殖技术受孕是不良结局的保护因素（OR＝0.389,P＜0.05）;胎龄（≤34周）、脐带异常、羊水粪染和5 min Apgar评分≤7是不良结局的独立危险因素（OR分别为4.434、4.731、3.424、18.958,P＜0.05）。结论：胎龄≤34周、脐带异常、羊水粪染或5 min Apgar评分≤7的双胎儿易出现新生儿期不良结局。［中国当代儿科杂志,2010,12（10）：777-780］     

维吾尔族和汉族足月新生儿低出生体重发生的危险因素比较

目的 比较维吾尔族(简称维族)和汉族足月新生儿低出生体重(LBW)发生的危险因素的不同,为预防和控制LBW 的发生提供依据.方法 2013 年3 月至2014 年6 月间足月LBW 新生儿 87 例为病例组(汉族38 例,维族49 例),同期足月正常体重儿186 例为对照组(汉族92 例,维族94 例),进行"低出生体重可能的环境危险因素"问卷调查,并采用多因素logistic 回归分析比较维汉族新生儿LBW 发生的危险因素.结果 维族LBW 新生儿出生体重低于汉族(P<0.05).多因素logistic 回归分析显示,父亲饮酒(OR=2.472,P=0.015)、吸烟(OR=2.323,P=0.007)、母孕期并发症(OR=14.377,P<0.001)、孕次(OR=2.995,P=0.001) 是汉族新生儿LBW 发生的危险因素; 父亲饮酒(OR=1.968,P=0.007)、母孕次(OR=1.953,P=0.005)、母孕期并发症(OR=10.283,P=0.002)、室内环境不良(OR=1.367,P=0.027)是维族新生儿LBW发生的危险因素.结论 维族和汉族足月LBW 新生儿的体格发育状况有差异.维汉族新生儿LBW 的发生在传统因素,如父亲饮酒等不良行为、孕母孕次和孕期并发症等上比较一致,但室内环境因素在维族新生儿LBW 的发生中也起了作用.     

孕期营养干预和代谢性危险因素对妊娠结局的影响

目的 探讨孕期营养干预和孕期代谢性危险因素对妊娠结局的影响。方法 研究对象为上海市国际和平妇幼保健院2010年5月至2012年4月接受常规产检并且分娩的孕妇。采用回顾性队列研究,在确诊为妊娠糖尿病(GDM)的孕妇中比较膳食干预组(接受膳食咨询) 和对照组(未接受膳食咨询)不良妊娠结局的差异,GDM诊断采用2010年国际糖尿病与妊娠研究组推荐标准。采用Logistics逐步回归分析母亲孕期危险因素对巨大儿发生的影响及作用大小。结果 ①10 421名孕妇的围生期信息进入数据分析。孕妇初诊时平均孕周20.8(19.4~22.4)周,初诊时空腹血糖(FBS)、三酰甘油(TG)和总胆固醇(CHOL)平均水平分别为(4.3±0.4)、(1.3±0.6)和(4.7±0.8) mmol·L-1,收缩压和舒张压的平均水平分别为(111.3±11.5)和(67.9±13.3)mmHg。高危孕妇的GDM的患病率为15.8%。新生儿平均出生体重(3 355.4±426.0) g,巨大儿发生率6.2%。②812名GDM孕妇中,干预组570例,对照组242例。两组孕妇年龄、文化程度、孕20周体重、初诊时血糖、血脂等基线水平均衡可比。干预组的新生儿出生体重、巨大儿发生率和妊娠期高血压发生率均低于对照组,分别为(3 347.4±19.6) vs (3 450.3±35.6) g(P=0.007)、6.7% vs 15.6%(P=0.001)和26.3% vs 47.9% (P<0.001)。随着营养干预次数的增加,孕中晚期体重增长量和新生儿出生体重均呈下降趋势(r=-0.126,P=0.003;r=-0.112,P=0.002),巨大儿的发生率也依次降低。③Logistic逐步回归分析显示,孕20周时体重(OR=1.08,95%CI:1.07～1.09)、孕中晚期体重增长量(OR=1.10,95%CI:1.07~1.12)和GDM(OR=1.63,95%CI:1.22~2.19)是巨大儿发生的危险因素。结论 对高危孕妇应考虑进行更早期的孕期危险因素管理以及膳食指导干预,控制孕期体重合理增长,有望减少不良妊娠结局的发生。     

绒毛膜羊膜炎与早产儿不良结局的研究进展

绒毛膜羊膜炎(chorioamnionitis,CAM)是指病原微生物进入羊膜腔后引起羊水、胎盘或胎儿的感染,是早产常见的原因,可能会导致不良新生儿结局[1-3].根据是否有临床表现和胎盘病理结果分为临床绒毛膜羊膜炎和组织学绒毛膜羊膜炎,其发生比例约为1:9[4].主要常见致病菌包括解脲脲原体、支原体、B族链球菌和葡萄...     

胎儿胸腔积液95例妊娠结局的影响因素分析

目的通过对95例胸腔积液胎儿及母体的多个因素进行分析, 了解其与妊娠结局的相关性。方法病例系列分析。对2016年1月至2022年10月郑州大学第三附属医院收治的95例胎儿胸腔积液(FHT)患者进行回顾性分析。根据妊娠结局, 分为引产组(13例)和分娩组(82例);对引产组患者的一般资料及胎儿遗传学检查进行分析, 了解其发病特点及遗传学规律;分娩组患者根据新生儿的Apgar评分分为正常组、窒息组, 对2组的孕妇年龄、首诊孕周、孕妇有无并发症或合并症、胎儿胸水的位置、胎儿胸腔积液的严重程度、孕期胎儿胸腔积液的转归、有无胎儿腹水、有无胎儿水肿、胎儿有无其他结构异常、羊水量、有无宫内治疗、分娩孕周、分娩方式、新生儿性别、新生儿体重15项一般资料采用χ2检验进行差异分析;以新生儿Apgar评分为因变量, 将上述单因素分析中具有统计学意义的变量纳入回归分析, 建立多因素二元Logistic回归方程, 探究影响妊娠结局的因素。结果正常组和窒息组间孕期胎儿胸腔积液的转归(消退/稳定/进展)(16/22/13例比2/18/11例, χ2=6.994, P=0.030)、胸腔积液严重程度(非重度/重度)(...     

足月胎儿主肺动脉超声收缩期加速时间/射血时间比值与新生儿肺成熟度关系的病例对照研究

背景：胎儿肺较其他器官发育得晚,且新生儿肺发育成熟度与妊娠结局密切相关。 目的：探讨足月胎儿主肺动脉超声收缩期加速时间（AT）/射血时间（ET）比值与新生儿肺成熟度的关系及预测价值。 设计：病例对照研究。 方法：以2019年10月至2020年10月在河南省新乡市中心医院行胎儿主肺动脉超声检查的孕妇为研究对象,按照分娩后胎儿羊水或气管抽吸液中板层小体（LB）是否≥50×109·L-1分为肺发育成熟组和肺发育不成熟组,比较两组临床资料、胎儿主肺动脉超声AT/ET比值;多因素Logistic回归分析影响新生儿肺成熟度的因素;Spearman相关性分析AT/ET比值与新生儿肺成熟度的相关性;绘制ROC曲线,分析AT/ET比值对新生儿肺成熟度的预测价值。 主要结局指标：胎儿主肺动脉超声AT/ET比值与新生儿肺成熟度的关系。 结果：102例孕妇及其胎儿主肺动脉超声图像和新生儿LB数据进入本文分析,孕产妇年龄23~36（29.4±1.0）岁,胎儿主肺动脉超声检查时孕周37＋1~38+6（38.3±0.1）周。肺发育成熟组76例,肺发育不成熟组26例。两组孕妇营养状况、胎儿呼吸样运动评分、收缩期峰值流速（PSV）、胎儿主肺动脉中段AT/ET比较,差异均有统计学意义（P＜0.05）。多因素Logistic回归分析显示,胎儿主肺动脉中段AT/ET是新生儿肺成熟度的影响因素（OR=0.881,95%CI：0.678~0.983）。 Spearman相关性分析显示,胎儿主肺动脉中段AT/ET比值与新生儿肺成熟度呈正相关（r=0.678,P=0.003）。ROC曲线显示,胎儿主肺动脉中段AT/ET预测新生儿肺成熟度最佳截断值为0.22时,敏感度为92.1%（95%CI：84.1%~97.4%）,特异度为84.6%（95%CI：70.9%~93.4%）,AUC为0.818（95%CI：0.715~0.927）,AT/ET比值预测新生儿肺成熟度Kappa值为0.812（P＜0.05）。 结论：足月胎儿主肺动脉超声AT/ET与新生儿肺成熟度密切相关,对新生儿肺成熟度有一定预测价值。     

妊娠期恶性肿瘤孕产妇和新生儿结局的前瞻性队列研究

目的：评估妊娠期恶性肿瘤孕产妇和新生儿结局。方法：多中心前瞻性队列研究。以第三军医大学3所附属医院作为队列研究现场,收集妊娠期病理诊断为恶性肿瘤且继续妊娠的连续病例（病例组）,所在医院每个病例以相同匹配条件并按照1∶1匹配建立对照组,截取两组孕产妇和新生儿信息,考察临床特征和母子结局,考察病例组化疗干预对病死率和存活儿童发育（年龄与发育进程问卷Ⅲ,ASQ Ⅲ）的影响因素。结果：2012至2016年3中心 80 524例孕妇进入本文分析,83例（1.03‰）孕妇在妊娠期诊断恶性肿瘤,2012年0.45‰至2016年1.28‰;截止至2017年9月1日35/83例（42.2％）死亡,排前5位肿瘤疾病占72.3%（60/83）：白血病26例,甲状腺癌和宫颈癌各10例,恶性卵巢瘤8例,乳腺癌6例;24名妊娠期恶性肿瘤的孕妇于妊娠28周前终止妊娠,8例平均在诊断恶性肿瘤后的（37.0±20.0）个月死亡;妊娠期恶性肿瘤继续妊娠59例行对照组1∶1匹配,继续妊娠59例中死亡27例（47.4%）,其中10例在孕中、晚期给予化疗,死亡1例（10.0%）,均未发生化疗相关的新生儿畸形。49例妊娠期恶性肿瘤孕妇未行化疗死亡26例（53.1%）,化疗亚组与非化疗亚组,孕妇病死率差异有统计学意义（P=0.016）。病例组与对照组比较、化疗亚组与非化疗亚组比较,ASQ Ⅲ差异均无统计学意义（P均=1.00）。结论：妊娠期化疗可降低孕产妇死亡率,但并不影响儿童病死率和生长发育。     

母体高尿酸血症对妊娠结局和新生儿合并症影响的回顾性巢式病例对照研究

背景：高尿酸血症（HUA）患病率逐年增高,不仅与痛风、尿酸盐肾病和肾结石有关,还与内分泌代谢、心脑血管等系统疾病的发生和发展有关。 目的：探讨孕母妊娠晚期血尿酸水平与不良妊娠结局、新生儿尿酸水平及新生儿合并症的关系。 设计：回顾性巢式病例对照研究。 方法：以2020年1~12月在北京大学人民医院产检的孕母为队列人群,根据孕母妊娠晚期血尿酸水平分为HUA组和非HUA组,比较两组妊娠结局和新生儿临床结局。根据孕母妊娠晚期血尿酸水平（μmol·L-1）分为低浓度（<360）、中浓度（~420）和高浓度（>420）,采用线性回归和Logistic 回归模型分析孕母血尿酸水平与早产、低出生体重、小于胎龄儿的关系。孕母妊娠晚期尿酸值及新生儿生后24 h尿酸值相关性分析采用Spearman秩相关分析。 主要结局指标：孕母血尿酸水平与早产、低出生体重和小于胎龄儿的关系。 结果：共纳入孕母2 397例（新生儿2 581例）,HUA组216例（9.0%）,非HUA组2 181例。HUA组孕母所生新生儿出生体重低于非HUA组（2 925 g vs 3 260 g,P<0.001）,差异均有统计学意义;而早产（18.5% vs 8.9%）、低出生体重（23.1% vs 7.1%）、小于胎龄儿（29.2% vs 10.6%）和转儿科比例（19.9% vs 11.1%）均高于非HUA组,差异均有统计学意义（P<0.001）。尿酸水平高浓度组孕母分娩的新生儿出生体重较低浓度组低54.0 g（95%CI：-106.5~-1.6,P=0.043）,发生早产的风险增加74%（OR=1.74,95%CI：1.08~2.8,P=0.023）,发生小于胎龄儿的风险增加85%（OR=1.85,95%CI：1.26~2.73,P=0.002）。新生儿生后24 h内尿酸水平与孕母妊娠晚期尿酸水平呈中等相关（r=0.613,P=0.000）。两组早产儿合并症差异无统计学意义。 结论：母体妊娠晚期HUA与早产、低出生体重、小于胎龄儿的发生相关。     

Placental Lesions Associated with Abnormal Growth in Twins

Abnormal growth in one or both twins may contribute to the increased morbidity and mortality observed in twin gestation. Our objective in this retrospective study of all twin pregnancies delivered at our hospital (n = 240) over a 2-year period was to study the relationship between placental lesions and abnormal growth. Standardized placental examinations were performed in 192 cases (80%), which constituted the study population. Two growth abnormalities were studied: discordant growth as defined by >15% difference in birth weight and small-for-gestational-age (SGA) birth as defined by birth weight less-than the 10th percentile for gestational age. The majority of twin pregnancies with either discordant growth (41/57 cases) or SGA birth (26/35 cases) had dichorionic placentas. In monochorionic placentas studied by injection there was no significant relationship between vascular anastomoses and discordant growth. Placental weight for small discordant and SGA twins was equivalent or increased relative to infant weight, a pattern not suggestive of maternal vascular underperfusion. Eight lesions, five considered to represent chronic placental disease and three considered to represent intrauterine adaptation, were studied as possible predictors of abnormal growth. The overall prevalence of these lesions in twin placentas was less than that seen in singleton births. Concordance between twin placentas for most lesions was higher than would be expected, based on their prevalence in singleton placentas. Two lesions were associated with discordant growth in both univariate and multivariate analyses: peripheral cord insertion (OR 3.6, 95% CI 1.7–7.6) and avascular villi (AV; OR 3.2, 95% CI 1.0–10.3). Three placental lesions were associated with SGA infants at the univariate level: peripheral cord insertion, avascular villi, and maternal vascular underperfusion. Only peripheral cord insertion (OR 9.8, 95% CI 4.1–23.4) and AV (OR 3.7, CI 1.0–13.7) were significant in the multivariate analysis. The relative increase in peripheral cord insertion and AV with abnormal growth was observed for both monochorionic and dichorionic placentas. Subgroups of discordant infants with and without SGA were both associated with peripheral cord insertion while only those with SGA had an increase in AV. Both peripheral cord insertion and AV were increased in the subgroup with SGA but no discordancy. In summary, two placental lesions, peripheral cord insertion indicating a spatially limited intrauterine compartment and AV indicating occlusion of fetal vessels in the placenta, were associated with abnormal growth in twins. Received November 20, 2000; accepted April 2, 2001.     

Effect of birth order on neonatal morbidity and mortality among very low birthweight twins: a population based study

OBJECTIVE: To study the effect of birth order on the risk for respiratory distress syndrome (RDS), chronic lung disease (CLD), adverse neurological findings, and death in very low birthweight (VLBW; < 1500 g) twins. METHODS: A population based study of VLBW infants from the Israel National VLBW Infant Database. The sample included all complete sets of VLBW twin pairs admitted to all 28 neonatal intensive care units between 1995 and 1999. Outcome variables were compared by birth order and stratified by mode of delivery and gestational age, using General Estimating Equation models, with results expressed as odds ratio (OR) with 95% confidence interval (CI). RESULTS: Second twins were at increased risk for RDS (OR 1.51, 95% CI 1.29 to 1.76), CLD (OR 1.36, 95% CI 1.11 to 1.66), and death (OR 1.24, 95% CI 1.02 to 1.51) but not for adverse neurological findings (OR 1.20, 95% CI 0.91 to 1.60). Mode of delivery did not significantly influence outcome. The odds ratio for RDS in the second twin was inversely related to gestational age, and the increased risk for RDS and CLD was found in both vaginal and caesarean deliveries. CONCLUSIONS: VLBW second twins are at increased risk for acute and chronic lung disease and neonatal mortality, irrespective of mode of delivery.     

产妇高龄对新生儿出生缺陷及生后并发症的影响

目的探讨产妇高龄对新生儿出生缺陷及生后并发症的影响。方法 2014年1月至2015年12月在云南省第一人民医院入住的1 109例新生儿中,选取年龄≥35岁的高龄产妇所产新生儿536例作为高龄组,随机选取同期分娩的年龄35岁的适龄产妇所产新生儿573例作为适龄组。比较两组产妇妊娠期合并症、胎儿宫内窘迫及新生儿出生缺陷、生后并发症等情况;通过单因素logistic回归分析产妇高龄对新生儿围产期合并症的影响。结果高龄组产妇剖宫产率、多胎次、妊娠期糖尿病、妊高症、试管婴儿、胎儿宫内窘迫发生率均显著高于适龄组,差异均有统计学意义(P0.01);高龄组新生儿唇腭裂发生率高于适龄组,骨骼畸形率低于适龄组(P0.05)。高龄是造成胎儿宫内窘迫(OR=2.27;95%CI:1.33~3.88;P=0.003)、新生儿复苏(OR=1.66;95%CI:1.19~2.31;P=0.003)和颅内出血(OR=2.70;95%CI:1.21~6.04;P=0.02)的危险因素。结论高龄产妇妊娠期合并症发生率高于适龄产妇,其所产新生儿唇腭裂发生率高于适龄产妇;产妇高龄会增加胎儿宫内窘迫、新生儿复苏抢救和颅内出血的风险。     

产妇年龄对新生儿不良结局影响的回顾性队列研究

目的 探讨不同怀孕年龄单胎妊娠产妇和新生儿不良结局的关系。方法 采用回顾性队列研究的方法,通过截取产科和新生儿科电子病例资料,获得2006年1月至2018年12月复旦大学附属妇产科医院住院单胎妊娠孕妇的社会人口学资料、孕产史及本次妊娠情况。按照分娩年龄不同将产妇分为低龄(<20岁)、适龄(~34岁)和高龄组(≥35岁)。分析各年龄组产妇相关特征的基线和妊娠的新生儿结局的发生率。组间比较采用χ²或Fisher精确检验。采用多自变量logistic回归模型,进行产妇亚组分析,以~34岁组为参考组,对<20、≥35岁组产妇,通过比值比(Crude OR)、调整比值比(Adjusted OR)和95％CI表示各产妇亚组相关的新生儿不良结局的风险。结果 2006至2014年高龄产妇比例6.9%~9.9%,2015、2016、2017和2018高龄产妇的比例分别为13.1%、13.8%、17.6%和19.6%。低龄组、高龄组在流动人口、初产妇、剖宫产比例方面与适龄组相比差异均有统计学意义(P均<0.001)。高龄组较适龄组胎产式为非头位者、不良孕产史、男性新生儿比例增加(P<0.05)。校正后低龄组和高龄组早产儿的发生率分别是适龄组的1.88倍(95%CI:1.34~2.65)和1.31倍(95%CI:1.21~1.42)。低龄组和高龄组中期早产儿的发生率分别是适龄组的2.83倍(95%CI:1.45~5.54)和1.34倍(95%CI:1.13~1.60),低龄组和高龄组晚期早产儿的发生率分别是适龄组的1.75倍(95%CI:1.22~2.51)和1.27倍(95%CI:1.17~1.36)。低龄组和高龄组低出生体重儿的发生率分别是适龄组的2.35倍(95%CI:1.66~3.33)和1.26倍(95%CI:1.16~1.37)。高龄组出生缺陷发生率是适龄组的1.39倍(95%CI:1.20~1.62)。结论 与适龄组相比,高龄组和低龄组产妇增加了早产、中期早产儿、晚期早产儿和低出生体重的风险。对低龄产妇应加强流动人口的管理,定期产检。对高龄产妇,应预防出生缺陷的发生,积极处理妊娠期并发症,加强孕中后期监护,预防围生期感染。本研究结果有助于不同怀孕年龄产妇的产前咨询和管理。     

Physical growth and cognitive abilities in concordant versus discordant birth weight twins at three years old

Background

Discordant birth weight twins have been shown to have high rates of adverse perinatal outcomes, but little is known about their growth and development.

Aim

To determine whether smaller and larger birth weight premature twins in concordant and discordant birth weight groups differ on measures of physical growth and intelligence at 3 years.

Study design

Prospective cohort study. Eight-four children, 52 concordant and 32 discordant birth weight twin pairs, were measured for height, weight, and head circumference and on intelligence at 3 years. Perinatal and demographic variables, including birth weight, head circumference, small for gestational age, zygosity, in vitro fertilization, gender and social class were recorded.

Results

Smaller and larger birth weight twins did not differ significantly from each other on any growth parameters in either concordant or discordant birth weight groups at 3 years of age. Smaller birth weight twins in the discordant birth weight group performed significantly less well on Verbal, Performance, and Full Scale IQ scores (Verbal IQ for smaller twins was 8.6 points lower, p < 0.005; Performance IQ, 11.9 points lower, p < 0.03; Full Scale IQ, 12.4 points lower, p < 0.004), but there were no significant intra-twin differences between larger and smaller birth weight concordant twins.

Conclusions

Smaller discordant birth weight twins performed significantly less well on intelligence, although they did not differ significantly from their larger twins on growth parameters at 3 years old. We conclude that smaller discordant birth weight twins had less optimal intra-uterine environments than their larger birth weight twin, which affected both their birth weights and brain development.     

双胎妊娠中母亲年龄和妊娠不良结局的关系

目的 探讨双胎妊娠中母亲年龄和妊娠不良结局的关系。方法 回顾性纳入2006年1月至2016年6月住院分娩的双胎妊娠产妇2 363例的临床资料。按照产妇年龄不同分为 < 20岁（n=15）、20~24岁（n=158）、25~29岁（n=894）、30~34岁（n=936）、35~39岁（n=320）、≥ 40岁（n=40）6组。比较各年龄组产妇相关特征的基线，以及其妊娠不良结局（早产、出生缺陷、妊娠晚期死胎、小于胎龄儿）的发生率。采用广义估计方程，评估各年龄组妊娠不良结局发生的风险。结果 控制了居住地、是否初产妇、妊娠方式、孕产期相关疾病因素后，≥ 40岁组产妇的极早产儿和中期早产儿发生率分别是25~29岁组的2.60倍、1.99倍（P < 0.05）；20~24岁组极早产儿、晚期早产儿的发生率分别是25~29岁组的1.99倍、1.33倍（P < 0.05）； < 20岁、20~24岁、≥ 40岁组妊娠晚期死胎的发生率分别是25~29岁组的9.10倍、2.88倍、3.97倍（P < 0.05）； < 20岁、35~39岁组小于胎龄儿的发生率分别是25~29岁组的2.70倍、0.73倍（P < 0.05）。结论 双胎妊娠中， < 20岁的产妇发生小于胎龄儿和妊娠晚期死胎的风险较高，≥ 40岁的产妇发生极早产儿、中期早产儿和妊娠晚期死胎的风险较高，20~24岁产妇发生极早产儿、晚期早产儿和妊娠晚期死胎的风险较高。     

Morbidity and mortality of discordant twins up to 34 weeks of gestational age

The combination of weight discordance and prematurity implies a high perinatal morbidity and mortality for the affected twins. Several pathomechanisms may be responsible for the weight difference in twins including a different genetic growth potential in dizygotic twins, placenta insufficiency in one twin, and chronic feto-fetal transfusion (CFFT). Little is known about neonatal morbidity and mortality of discordant twins. Therefore, a retrospective, case-controlled study on preterm discordant twins up to 34 weeks gestation was carried out. Twenty-seven (27,3%) of 99 twin pairs born in our clinic had a birth weight difference of more than 20%. The control group consisted of 27 non-discordant twins matched for gestational age. Discordant twins showed a significantly higher mortality (19%) than the control twins (2%). Severe intracranial haemorrhage (ICH) and persistent ductus arteriosus Botalli (PDA) were found more often in discordant twins than in the control group. The increased mortality and morbidity of discordant twins compared with concordant twins matched for gestational age indicates that the increased morbidity and mortality of preterm weight discordant twins is not only due to prematurity, but is also related to the discordance itself. Thirteen (48.1%) of the weight discordant twin pairs fulfilled the criteria for CFFT. Twins with CFFT differed significantly from controls with respect to the incidence of mortality and the rate of severe ICH, PDA, and the necessity of postnatal cardiopulmonary resuscitation. By contrast, no significant differences were found between discordant twins without CFFT and controls. Thus, CFFT appears to be a major contributing factor for increased mortality and morbidity of weight discordant twins. Intra-twin pair analysis revealed a higher rate of postnatal hypoglycaemia in the smaller twins only, probably caused by insufficient glycogen storage due to intra-uterine malnutrition. Mortality was the same for both the larger and the smaller twins. It may be concluded that neonatal outcome of smaller twins who have survived intra-uterine malnutrition is the same as in larger twins. Intra-twin pair analysis in twins with CFFT revealed no significant differences except for a higher rate of ICH grade 2–4 in the larger twins which might be explained by hypervolaemia of the recipient.Conclusion Morbidity and mortality of weight discordant twins are increased. CFFT appears to be a major contributing factor for the increased mortality and morbidity. Postnatal mortality was the same in acceptor and donor; however, the acceptor had a higher postnatal morbidity.     

新生儿先天性甲状腺功能减低症危险因素的Meta分析

目的 探讨新生儿先天性甲状腺功能减低症(congenital hypothyroidism,CH)的危险因素,为CH的预防提供参考依据.方法 系统收集中国生物医学文献数据库、中国知网、维普中文期刊数据库、万方数据库、PubMed、Web of Science、Embase、SpringerLink、Elsevier/S...