The relationship between maternal body mass index and pregnancy outcomes in twin compared with singleton pregnancies
The relationship between maternal body mass index and pregnancy outcomes in twin compared with singleton pregnancies
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DOI：
10.1038/s41366-019-0362-8
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发表时间：
2020-01-01
影响因子：
4.9
通讯作者：
Melamed, Nir
中科院分区：
文献类型：
--
作者：
Ram, Maya;Berger, Howard;Melamed, Nir
目的有双胞胎的妇女先天增加与母亲肥胖相关的许多并发症的风险。因此，母亲肥胖对双胞胎的影响可能不同于报道的单胞胎。此外，考虑到双胞胎妊娠的代谢需求增加，与单胎妊娠相比，双胞胎母亲体重不足的影响可能更大。我们的目标是检验双胞胎和单胎孕妇孕前体重指数(BMI)与不良妊娠结局之间的关系的假设。方法这是一项基于人群的回顾性研究，研究对象是加拿大安大略省2012年4月至2016年3月期间在医院分娩的所有单胞胎或双胞胎女性。数据来自安大略省更好的结果登记和网络(Born)。在双胎和单胎妊娠中，分别评估母亲BMI类别与妊娠并发症的关系。主要结果是一个复合变量，其中包括以下任何并发症：先兆子痫、妊娠期糖尿病或32(0/7)周前的早产。根据WHO定义的每一BMI类别(以正常体重类别为参考)的不良结果的相对风险(ARR)和95%可信区间(CI)是使用修正的泊松回归计算的，并调整了母亲年龄、未分娩、吸烟、先前早产和胎儿性别。结果487,870名单胎孕妇(n=480,010)和双胞胎孕妇(n=7860)符合纳入标准。在单胎和双胎妊娠中，母亲BMI较高时，合并初级结局、先兆子痫、妊娠期糖尿病和剖宫产的风险增加，但双胞胎中这些关联比单胎妊娠弱(BMI和Gt；=40.0 kg/m(2)与主要结局的相关性：单胎的ARR=3.10，95%-CI 2.96-3.24，双胞胎的ARR=1.74，95%-CI 1.37-2.20)。在单胎妊娠中，32周(0/7)周的早产风险随着母亲BMI的增加而增加，这主要是由于提供者发起的早产风险增加。然而，在双胎妊娠中，体重不足(但不是超重或肥胖)与32周时早产的风险最大(ARR 1.67，95%-CI 1.17-2.37)，主要是由于自发早产的风险增加(ARR 2.10，95%-CI 1.44-3.08)。结论在双胎妊娠的健康妇女中，体重不足与早产的风险最大，而母亲肥胖与不良妊娠结局的关联弱于单身孕妇。
Objecive Women with twins have an a priori increased risk for many of the complications associated with maternal obesity. Thus, the impact of maternal obesity in twins may differ from that reported in singletons. In addition, given the increased metabolic demands in twin pregnancies, the impact of maternal underweight may be greater in twin compared with singleton gestations. Our objective was to test the hypothesis that the relationship between maternal pre-pregnancy body mass index (BMI) and adverse pregnancy outcomes differ between twin and singleton gestations. Methods This was a retrospective population-based study of all women who had a singleton or twin hospital birth in Ontario, Canada, between April 2012 and March 2016. Data were obtained from the Better Outcomes Registry & Network (BORN) Ontario. The relationship between maternal BMI category and pregnancy complications was assessed separately in twin and singleton gestations. The primary outcome was a composite variable that included any of the following complications: preeclampsia, gestational diabetes, or preterm birth before 32(0/7) weeks. Relative risk (aRR) and 95% confidence intervals (CI) for adverse outcomes for each BMI category as defined by WHO (using normal weight category as reference) were generated using modified Poisson regression, adjusting for maternal age, nulliparity, smoking, previous preterm birth, and fetal sex. Results A total of 487,870 women with singleton (n = 480,010) and twin (n = 7860) pregnancies met the inclusion criteria. The risk of the composite primary outcome, preeclampsia, gestational diabetes, and cesarean delivery increased with high maternal BMI in both singleton and twin gestations, but these associations were weaker in twin compared with singleton gestations (association of BMI >= 40.0 kg/m(2) with primary outcome: aRR = 3.10, 95%-CI 2.96-3.24 in singletons compared with aRR = 1.74, 95%-CI 1.37-2.20 in twins). In singleton pregnancies the risk of preterm birth at < 32(0/7) weeks increased with maternal BMI, mainly due to an increased risk of provider-initiated preterm birth. In twin gestations, however, underweight (but not overweight or obesity) was associated with the greatest risk of preterm birth at < 32 weeks (aRR 1.67, 95%-CI 1.17-2.37), mainly due to an increased risk of spontaneous preterm birth (aRR 2.10, 95%-CI 1.44-3.08). Conclusion In healthy women with twin pregnancies, underweight is associated with the greatest risk for preterm birth, while the association of maternal obesity with adverse pregnancy outcomes is weaker than that observed in singletons.