Modifiable risk factors for growth restriction in twin pregnancies
Modifiable risk factors for growth restriction in twin pregnancies
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DOI：
10.1016/j.ajog.2004.12.071
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发表时间：
2005-05-01
影响因子：
9.8
通讯作者：
Istwan, N
中科院分区：
文献类型：
--
作者：
Schwendemann, WD;O'Brien, JM;Istwan, N
目的：本研究旨在评估双胎妊娠中胎儿生长不良的可改变的危险因素，研究设计：一项大型队列研究，从一个数据库中的妇女与双胎妊娠确定早产的风险进行。检查每个婴儿的出生体重和分娩时的胎龄，使用亚历山大参考曲线将婴儿分为平均胎龄（阿加）、大胎龄（LGA）或小胎龄（SGA）。使用Pearson卡方检验和逻辑回归分析比较了至少分娩1个SGA婴儿和阿加对的患者的临床和人口统计学因素。与SGA分娩相关的危险因素包括吸烟、体重增加不佳、孕前瘦体重指数、非裔美国人种族和未婚。Logistic回归分析表明，烟草滥用是胎儿生长不良的最大风险因素（比值比[OR] 1.95; 95%CI [1.68，2.27]）。体重增加小于0.5lb/wk也会增加SGA风险（OR 1.35; 95%CI [1.16，1.68]），而体重增加大于1 lb/wk则会降低SGA风险（OR 0.77; 95%CI [0.68，0.86]）。结论：吸烟和体重增加是可改变的危险因素，需要在双胎妊娠期间进行干预。应鼓励患者停止吸烟，并在妊娠后期每周至少增加半磅体重，以尽量减少生长受限的风险。(c)2005年爱思唯尔公司All rights reserved.
Objective: This study was undertaken to evaluate modifiable risk factors for adverse fetal growth in twin pregnancies.Study design: A large cohort study from a database of women with twin gestations identified at risk for preterm labor was performed. Examining each infant's birth weight and gestational age at delivery, infants were classified as being average (AGA), large (LGA), or small (SGA) for gestational age, using the Alexander reference curve. Clinical and demographic factors were compared between patients delivering at least 1 SGA infant and AGA pairs using Pearson's chi(2) Student t test statistics and logistic regression.Results: There were 11,827 twin pregnancies evaluated. Risk factors associated with SGA deliveries included tobacco abuse, poor weight gain, lean prepregnancy body mass index, African American race, and nonmarried. The logistic regression identified tobacco abuse as the single greatest risk for poor fetal growth, (odds ratio [OR] 1.95; 95% CI [1.68, 2.27]). Weight gain of less than one-half lb/wk also increased SGA risk (OR 1.35; 95% Cl [1.16, 1.68]), whereas weight gain greater than 1 lb/wk decreased SGA risk (OR 0.77; 95% CI [0.68, 0.86]).Conclusion: Tobacco abuse and weight gain are the modifiable risk factors, which require intervention during a twin pregnancy. Patients should be encouraged to stop tobacco abuse and gain a minimum of one-half lb/wk in the later half of pregnancy to minimize the risk for growth restriction. (c) 2005 Elsevier Inc. All rights reserved.