西南地区双绒双胎孕妇最佳孕期增重的回顾性研究

A retrospective study on optimal gestational weight gain of double chorionic twin pregnant women in southwest China

摘要:

目的： 探讨不同孕前体质指数（body mass index，BMI）的双绒双胎妊娠孕妇最佳的孕期体质量增加值（gestational weight gain，GWG）。方法： 把在重庆市妇幼保健院分娩的双胎妊娠孕妇分为良好结局组和不良结局组，再根据孕前BMI进行分层：低体质量（BMI<18.5 kg/m²）、正常（18.5≤BMI<24.0 kg/m²）、超重（24.0≤BMI<28.0 kg/m²）、肥胖（BMI≥28.0 kg/m²）。本课题组用2种方法确定孕期体质量增加的最佳范围。第一种方法是基于统计的方法：通过四分位法获得良好结局组不同BMI中GWG的范围以得到最佳GWG范围。第二种方法是基于结果的方法，计算出孕期体质量增加率（gestational weight gain rate，GWGR），通过比较在最佳GWGR之内和最佳GWGR之外的孕妇并发症发生率以验证最佳GWG的合理性。结果： 本研究计算得到的最佳GWG低于美国医学研究所（Institute of Medicine，IOM）推荐的GWG。除肥胖组外，其他3个BMI组孕期增重在最佳GWG范围内的孕期并发症发病率均低于最佳GWG范围外的孕妇。GWGR不足会增加妊娠糖尿病、胎膜早破、早产和胎儿生长受限的风险。GWGR增加过多会增加妊娠期高血压和子痫前期的风险。结论： 本研究提供了初步的西南地区双绒双胎妊娠最佳GWG建议（低体质量为16.0~21.0 kg，正常为14.5~21.0 kg，超重为13.0~20.0 kg），肥胖组由于样本量的限制而不做推荐。

Abstract:

Objective: To explore the optimal gestational weight gain (GWG) of twin pregnant women with different pre-pregnancy body mass index (BMI) through the range of uncomplicated twin pregnant women. Methods: We divided pregnant women with twin pregnancies who delivered in Chongqing Maternal and Child Health Care Hospital into excellent outcome group and poor outcome group. Then, according to the pre-pregnant BMI, they were classified as underweight (BMI<18.5 kg/m²) , normal (18.5≤BMI<24.0 kg/m²) , overweight (24.0≤BMI<28.0 kg/m²) , and obese (BMI≥28.0 kg/m²). We used two methods to determine the optimal range of GWG. The first was a statistics-based approach: calculating the interquartile range of GWG for different BMIs in the excellent outcome group. The second method was the outcome-based method. To verify the rationality of optimal weekly GWG, we calculated the GWG rate (GWGR, total gestational weight gain/gestational weeks) and compared the incidence of maternal complications within and outside the optimal GWGR. Results: The optimal GWG calculated in this study was lower than the GWG recommended by the Institute of Medicine (IOM). Except for the obese group, the overall incidence in the other three BMI groups within the optimal GWG was lower than that outside the optimal GWG. Insufficient GWGR increased the risk of gestational diabetes, premature rupture of membranes, preterm birth, and fetal growth restriction. Excessive GWGR increases the risk of gestational hypertension and preeclampsia. Conclusion: Due to the limited sample size, except for the obese group, we provide preliminary recommendations for the optimal GWG in double chorionic twin pregnancies in China (16.0-21.0 kg for underweight, 14.5-21.0 kg for normal, and 13.0-20.0 kg for overweight).