Gestational Diabetes in Twin Versus Singleton Pregnancies With Normal Weight or Overweight Pre-Pregnancy Body Mass Index: The Mediating Role of Mid-Pregnancy Weight Gain.
Gestational Diabetes in Twin Versus Singleton Pregnancies With Normal Weight or Overweight Pre-Pregnancy Body Mass Index: The Mediating Role of Mid-Pregnancy Weight Gain.
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DOI：
10.1097/ede.0000000000001454
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发表时间：
2022-03-01
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影响因子：
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通讯作者：
Hutcheon JA
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作者：
Dimitris MC;Kaufman JS;Bodnar LM;Platt RW;Himes KP;Hutcheon JA
虽然妊娠期糖尿病在双胞胎妊娠中可能比单胞胎妊娠更常见，但原因尚不清楚。我们评估了在正常体重和超重的孕前体重指数（BMI）分层中，怀孕中期体重增加较高的解释这种关系的程度。我们分析了从1998-2013年在宾夕法尼亚州Magee妇女医院分娩的孕前BMI正常或超重的双胞胎（n =1397）和单胞胎（n=3117）妊娠的病历中提取的连续体重和葡萄糖筛查和诊断数据。我们使用因果中介分析来估计双胎妊娠与单胎妊娠对妊娠期糖尿病的总影响，以及由涉及中期妊娠体重增加的途径介导（自然间接影响）和不介导（自然和受控直接影响）的影响。双胞胎妊娠中患妊娠糖尿病的几率更高[总效应的比值比（OR）=2.83（95% CI 1.54; 5.19）正常体重和2.09（95% CI 1.16; 3.75）对于超重的孕前BMI]，然而，有限的证据表明，这种关系是由体重增加介导的[自然间接效应的OR =1.21（95% CI 0.95; 1.54）正常体重和1.06（95% CI 0.92; 1.21），妊娠前BMI超重]，更多证据表明通过其他途径介导[自然直接效应的OR =2.34（95% CI 1.24; 4.40）正常体重和1.97（95% CI 1.08; 3.60）超重孕前BMI]。虽然体重正常或孕前BMI超重的双胞胎妊娠与单胞胎相比，患妊娠期糖尿病的几率更高，但这种影响的大部分原因是不涉及妊娠中期体重增加的途径。
Although gestational diabetes might be more common in twin versus singleton pregnancies, reasons for this are unclear. We evaluated the extent to which the relationship is explained by higher mid-pregnancy weight gain within normal weight and overweight pre-pregnancy body mass index (BMI) strata. We analyzed serial weights and glucose screening and diagnostic data abstracted from medical charts for twin (n=1397) and singleton (n=3117) pregnancies with normal or overweight pre-pregnancy BMI delivered from 1998–2013 at Magee Women’s Hospital in Pennsylvania. We used causal mediation analyses to estimate the total effect of twin versus singleton pregnancy on gestational diabetes, as well as those mediated (natural indirect effect) and not mediated (natural and controlled direct effects) by pathways involving mid-pregnancy weight gain. Odds of gestational diabetes were higher among twin pregnancies [odds ratios (ORs) for total effect=2.83 (95% CI 1.54; 5.19) for normal weight and 2.09 (95% CI 1.16; 3.75) for overweight pre- pregnancy BMI], yet there was limited evidence that this relationship was mediated by weight gain [ORs for natural indirect effect=1.21 (95% CI 0.95; 1.54) for normal weight and 1.06 (95% CI 0.92; 1.21) for overweight pre-pregnancy BMI], and more evidence of mediation via other pathways [ORs for natural direct effect=2.34 (95% CI 1.24; 4.40) for normal weight and 1.97 (95% CI 1.08; 3.60) for overweight pre-pregnancy BMI]. While twin pregnancies with normal weight or overweight pre-pregnancy BMI experience higher odds of gestational diabetes versus singletons, most of this effect is explained by pathways not involving mid-pregnancy weight gain.