Journal of Developmental Medicine(Electronic Version)  2020, Vol. 8 Issue (2): 151-156 DOI: 10.3969/j.issn.2095-5340.2020.02.011 |
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| Risk factors and perinatal outcomes of twin pregnancies with growth discordance |
| Pan Yulin, Cui Qiliang
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| 1. Neonatology Department, Third Affiliated Hospital of Guangzhou Medical University, Guangdong, Guangzhou 510150, China; 2. Neonatology Department, Shenzhen Bao'an District Songgang People's Hospital, Guangdong, Shenzhen 518108, China |
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Abstract 【Abstract】 Objective To explore the incidence, adverse maternal and infant outcomes and relatedrisk factors of discordant twins, in order to provide reference for prevention of discordant twins andimprovement of neonatal outcomes. Methods From January 2017 to June 2018, 2 912 cases of twinpregnant women and 5 824 cases of newborn were included among the pregnant women in the ThirdHospital Affiliated to Guangzhou Medical University. They were divided into discordant group (the birth
weight difference of the two newborns ≥ 20%) and normal group (the birth weight difference of the twonewborns<20%). According to the medical records and follow-up registrations, the clinical data of pregnantwomen and newborns were recorded. The perinatal outcomes of the two groups were compared, and therisk factors of discordant twins were analyzed. Independent sample t-test, χ2 test and stepwise Logisticregression analysis were used for statistical analysis. Results In 2 912 cases of twin pregnant women, therate of discordant twins was 3.54% (103/2 912). The birth weight of the discordant group was lower than
that in the normal group, and the length of hospitalization, the proportion of infants with small gestationalage and the age of the lowest birth weight were all higher than that in the normal group (P<0.05). Multivariatelogistic regression analysis showed that age > 30 years old (OR=1.853), gestational age ≤ 35 weeks(OR=2.368), gravida ≥ 2 times (OR=2.941), pre-pregnancy BMI ≤ 25 kg/m2 (OR=2.457), gestationaldiabetes mellitus (OR=3.624), gestational hypertension (OR=1.725), monochorionic monoamniotic(MCMA) twin (OR=2.529), and twin heterosis (OR=1.603) were the influencing factors of discordant
twins (P<0.05). The incidence of maternal infection, polyhydramnios, oligohydramnios, premature ruptureof membranes, premature delivery, postpartum hemorrhage, fetal growth restriction, neonatal infectiouspneumonia, neonatal asphyxia, fetal distress, neonatal hypoglycemia, hyperbilirubinemia and neonataldeath in the discordant group were higher than that in the normal group (P<0.05). The 103 cases withdiscordant twin were divided into three subgroups: MCMA, monochorionic diamniotic (MCDA) anddichorionic diamnionic (DCDA). The incidence of maternal infection, polyhydramnios, oligohydramnios,
premature rupture of membranes, postpartum hemorrhage, fetal growth restriction, neonatal asphyxia andhypoglycemia were significantly different among the three subgroups. The incidences of the above indexesin the MCMA group were higher than those in the MCDA and DCDA groups (P<0.05). ConclusionsDiscordant twin pregnancy increases the risk of adverse outcomes of pregnant women and newborns.Discordant twin pregnancy is closely related to the factors such as maternal age, gestational weeks,gestational times, pre-pregnancy BMI, gestational diabetes, gestational hypertension, MCMA twin and twin
heterosexuality.
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Received: 16 July 2019
Published: 23 April 2020
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