Gestational diabetes mellitus is associated with adverse outcomes in twin pregnancies
Gestational diabetes mellitus is associated with adverse outcomes in twin pregnancies
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妊娠期糖尿病与双胎妊娠的不良结局相关
DOI：
10.1016/j.ajog.2018.10.027
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发表时间：
2019-01-01
影响因子：
9.8
通讯作者：
Melamed, Nir
中科院分区：
文献类型：
--
作者：
Hiersch, Liran;Berger, Howard;Melamed, Nir
背景：在单胎妊娠中，妊娠期糖尿病与不良结局相关。在双胞胎妊娠中，考虑到早产率较高以及其中一些并发症的先验风险增加，这种关联可能会减弱。目的：我们的目的是检验以下假设：与单胎妊娠相比，双胞胎妊娠期糖尿病与不良妊娠结局的可能性较小。方法：这项回顾性队列研究包括2012-2016年加拿大安大略的所有双胞胎和单胎活产婴儿。妊娠结局在有与无妊娠期糖尿病的妇女之间进行比较，分别分析双胎和单胎分娩。调整后的风险比和95%的置信区间，采用改良泊松回归，调整前胎年龄，未产妇，吸烟，种族，体重指数，预先存在的高血压，和辅助生殖technology.RESULTS：共270,843名妇女与单胎（n = 266,942）和双胎（n = 3901）妊娠符合纳入标准。在双胞胎和单胞胎组中，妊娠期糖尿病与（校正的风险比，[95%置信区间]）剖宫产（分别为1.11 [1.02-1.21]和1.20 [1.17-1.23]）和早产相关，
BACKGROUND: Among singleton pregnancies, gestational diabetes mellitus is associated with adverse outcomes. In twin pregnancies, this association may be attenuated, given the higher rate of prematurity and the a priori increased risk of some of these complications.OBJECTIVE: Our aim was to test the hypothesis that gestational diabetes mellitus is less likely to be associated with adverse pregnancy outcomes in twin compared with singleton gestations.METHODS: This retrospective cohort study comprised all twin and singleton live births in Ontario, Canada, 2012-2016. Pregnancy outcomes were compared between women with vs without gestational diabetes mellitus, analyzed separately for twin and singleton births. Adjusted risk ratios and 95% confidence intervals were generated using modified Poisson regression, adjusting formaternal age, nulliparity, smoking, race, body mass index, preexisting hypertension, and assisted reproductive technology.RESULTS: A total of 270,843 women with singleton (n = 266,942) and twin (n = 3901) pregnancies met the inclusion criteria. In both the twin and singleton groups, gestational diabetes mellitus was associated with (adjusted risk ratio, [95% confidence interval]) cesarean delivery (1.11 [1.02-1.21] and 1.20 [1.17-1.23], respectively) and preterm birth at