Perinatal outcomes in twin pregnancies complicated by gestational diabetes.
Perinatal outcomes in twin pregnancies complicated by gestational diabetes.
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双胎妊娠合并妊娠期糖尿病的围产儿结局。
DOI：
10.1016/j.ajogmf.2021.100396
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发表时间：
2021-09
影响因子：
6.3
通讯作者：
中科院分区：
文献类型：
--
作者：
单胎妊娠期糖尿病会增加大胎龄儿、妊娠高血压疾病和新生儿发病率的风险。与单胎妊娠相比，双胎妊娠发生胎儿生长异常、高血压疾病和新生儿发病率的风险增加。妊娠期糖尿病是否会进一步增加这些结果的风险尚不清楚。我们试图确定在大量双胎妊娠队列中妊娠糖尿病与先兆子痫、胎儿生长异常和新生儿重症监护病房入院风险之间的关系。我们使用了1998年至2013年在我院分娩的所有双胞胎的回顾性队列。我们排除了24周前分娩的孕妇、单绒毛膜-单羊膜双胞胎和既往患有糖尿病的患者。妊娠糖尿病定义为卡朋特库斯坦标准定义的100克3小时葡萄糖激发试验的两个异常值或50克葡萄糖试验后的一个小时值200mg/dL。多变量泊松回归模型用于估计妊娠糖尿病和先兆子痫之间的关联，胎龄小，胎龄大，入新生儿重症监护病房，调整孕前体重指数，母亲种族，母亲年龄，胎次，使用体外受精，孕前吸烟和慢性高血压作为混杂因素。未调整的妊娠期糖尿病发病率为6.5% （n=167）。患有妊娠糖尿病的妇女比没有妊娠糖尿病的妇女更有可能年龄在35岁或以上，患有肥胖症，并且通过体外受精怀孕。先兆子痫在合并妊娠期糖尿病的双胎妊娠中更为常见：31%，而在没有妊娠期糖尿病的双胎妊娠中为18% （aRR= 1.5; 95% CI, 1.1, 2.1）。与没有妊娠糖尿病的妇女（24%）相比，妊娠糖尿病妇女（17%）的小胎龄婴儿诊断较少，尽管结果不精确，aRR= 0.8（0.5, 1.1）。妊娠期糖尿病与胎龄或新生儿重症监护病房入院没有关联。在35周妊娠期糖尿病患者中，62% （n=60）需要医疗管理。妊娠期糖尿病是双胎妊娠子痫前期的一个危险因素。密切的血压监测和患者教育对这一高危人群至关重要。妊娠期糖尿病与双胎妊娠新生儿结局之间的关系尚不明确，尽管它可能对胎龄较小的婴儿有保护作用。需要前瞻性研究来确定血糖控制是否能降低双胎妊娠糖尿病患者先兆子痫的风险。
Gestational diabetes in singleton pregnancies increases the risk of large for gestational age infants, hypertensive disorders of pregnancy, and neonatal morbidity. Compared to singleton gestations, twin gestations are at increased risk for fetal growth abnormalities, hypertensive disorders and neonatal morbidity. Whether gestational diabetes further increases the risk of these outcomes is unclear. We sought to determine the relation between gestational diabetes and the risk of preeclampsia, fetal growth abnormalities, and NICU admission in a large cohort of twin pregnancies. We used a retrospective cohort of all twin deliveries at our institution from 1998 to 2013. We excluded pregnancies delivered before 24 weeks, monochorionic-monoamniotic twins, and patients with pre-existing diabetes for a final cohort of 2,573 twin deliveries. Gestational diabetes was defined as two abnormal values on a 100 gram, three-hour glucose challenge test as defined by Carpenter Coustan Criteria or a one-hour value 200mg/dL after a 50 gram glucose test. Multivariable Poisson regression models were used to estimate associations between gestational diabetes and preeclampsia, small for gestational age, large for gestational age and admission to the NICU, after adjustment for pre-pregnancy body mass index, maternal race, maternal age, parity, use of in vitro fertilization, pre-pregnancy smoking, and chronic hypertension as confounders. The unadjusted incidence of gestational diabetes was 6.5% (n=167). Women with gestational diabetes were more likely than women without gestational diabetes to be 35 years or older, living with obesity, and have conceived with in vitro fertilization. Preeclampsia was more common among twin pregnancies complicated by gestational diabetes: 31% compared to 18% in twin pregnancies without gestational diabetes (aRR= 1.5; 95% CI, 1.1, 2.1). A diagnosis of small for gestational age infant was less common among women with gestational diabetes (17%) compared to women without gestational diabetes (24%), although results were imprecise aRR= 0.8 (0.5, 1.1). There was no association between gestational diabetes and large for gestational age or NICU admission. Among women with gestational diabetes who reached 35 weeks, 62% (n=60) required medical management. Gestational diabetes is a risk factor for preeclampsia among twin pregnancies. Close blood pressure monitoring and patient education are critical for this high risk group. The association between gestational diabetes and neonatal outcomes in twin pregnancies is less precise, although it may be protective against a small for gestational age infant. Prospective studies to determine if glycemic control decreases risk of preeclampsia in twin pregnancies with gestational diabetes are needed.
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影响因子：
9.8
作者：
Hiersch, Liran;Berger, Howard;Melamed, Nir
通讯作者：
Melamed, Nir
DOI：
10.1136/bmj.c1395
发表时间：
2010-04-01
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Horvath K;Koch K;Jeitler K;Matyas E;Bender R;Bastian H;Lange S;Siebenhofer A
通讯作者：
Siebenhofer A
影响因子：
--
作者：
Kelley KW;Carroll DG;Meyer A
通讯作者：
Meyer A
影响因子：
9.8
作者：
Carter, Ebony B.;Bishop, Katherine C.;Cahill, Alison G.
通讯作者：
Cahill, Alison G.
影响因子：
4.5
作者：
Lai, Florence Y.;Johnson, Jeffrey A.;Kaul, Padma
通讯作者：
Kaul, Padma