双胎妊娠并发子痫前期的发病趋势、特征及危险因素分析

陈维; 王子莲

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双胎妊娠并发子痫前期的发病趋势、特征及危险因素分析

临床研究 | 更新时间：2023-11-01

- 双胎妊娠并发子痫前期的发病趋势、特征及危险因素分析
- Analysis of The Tendency， Characteristic and Risk Factors of Twin Pregnancy Complicated with Preeclampsia
- 中山大学学报（医学科学版） 2021年42卷第1期页码：145-153
- 作者机构：
  
  中山大学附属第一医院妇产科，广东广州510080
- 作者简介：
  
  陈维，在读硕士研究生，研究方向：围产医学；E-mail：13027719370@163.com
- 基金信息：
  
  中山大学临床医学研究5010计划项目(2012004)
- DOI：
  中图分类号： R714.23
- 纸质出版日期：2021-01-20，
  
  收稿日期：2020-11-12，
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陈维,王子莲.双胎妊娠并发子痫前期的发病趋势、特征及危险因素分析[J].中山大学学报（医学科学版）,2021,42(01):145-153.

CHEN Wei,WANG Zi-lian.Analysis of The Tendency， Characteristic and Risk Factors of Twin Pregnancy Complicated with Preeclampsia[J].Journal of Sun Yat-sen University(Medical Sciences),2021,42(01):145-153.
陈维,王子莲.双胎妊娠并发子痫前期的发病趋势、特征及危险因素分析[J].中山大学学报（医学科学版）,2021,42(01):145-153. DOI：

CHEN Wei,WANG Zi-lian.Analysis of The Tendency， Characteristic and Risk Factors of Twin Pregnancy Complicated with Preeclampsia[J].Journal of Sun Yat-sen University(Medical Sciences),2021,42(01):145-153. DOI：

摘要

目的

探讨双胎妊娠并发子痫前期的发病趋势、特征及危险因素。

方法

回顾性分析2011年1月至2019年12月在中山大学附属第一医院住院分娩的1 542例双胎妊娠孕妇子痫前期的发病趋势。最终1 384例双胎妊娠孕妇纳入后续发病特征及危险因素分析，根据绒毛膜性将其分为单绒毛膜性（monochorionic，MC）组和双绒毛模性（dichorionic， DC）组，MC共有403例，其中子痫前期（preeclampsia， PE）组55例，非PE组348例；DC共有981例，其中PE组105例，非PE组876例；分别比较不同绒毛膜性孕妇PE组和非PE组的基本资料和分娩结局，采用单因素分析和多因素Logistic回归分析不同绒毛膜性双胎妊娠发生子痫前期的危险因素。

结果

双胎妊娠PE的总发病率为10.4%，2011-2019年各年PE的发病率在7.8%～11.8%之间波动。无论MC与DC双胎妊娠，PE组孕妇贫血（MC为58.2%和39.7%，

=0.010；DC为59%和38%，

=0.000）、低蛋白血症（MC为7.3%和1.7%，

=0.035；DC为10.5%和0.7%，

=0.000）、早产（MC为94.5%和70.1%，

0.000；DC为89.5%和54.8%，

=0.000）、产后出血（MC为21.8%和10.6%，

=0.018；DC为20.9%和13.4%，

=0.035）、新生儿转新生儿重症监护室（MC为49.1% 和28.6%，

=0.000；DC为26.7%和15.6%，

=0.000）的发生率均较非PE组高，组间差异有统计学意义；DC双胎妊娠PE组小胎出生体质量和大胎出生体质量均较非PE组轻，组间差异有统计学意义（

0.000；

=0.017）。孕期增重过多、辅助生殖技术受孕是MC双胎PE的独立危险因素；孕前BMI≥24 kg/m

、孕期增重过多、双胎体质量差过大是DC双胎妊娠PE的独立危险因素。

结论

双胎妊娠PE的发病率波动于7.8%～11.8%；不同绒毛膜性双胎妊娠PE的危险因素和分娩结局略有差异；孕期增重过多、辅助生殖技术受孕、孕前BMI≥24 kg/m

、双胎体质量差过大是双胎妊娠PE的危险因素，提示孕期体质量管理尤为重要。

Abstract

Objective

To investigate the tendency， characteristic and risk factors of twin pregnancy complicated with preeclampsia.

Methods

A retrospective analysis was performed on the incidence trend of preeclampsia in 1542 twin pregnant women who were hospitalized for delivery in the First Affiliated Hospital of Sun Yat-sen University from January 2011 to December 2019. Finally， 1384 twin pregnant women were included in the analysis of subsequent morbidity characteristics and risk factors， who were divided into Monochorionic （MC） group and Dichorionic （DC） group according to chorionicity. There were 403 MC cases， including 55 cases in Preeclampsia （PE） group and 348 cases in non-PE group and 981 DC cases， including 105 cases in PE group and 876 cases in non-PE group. The basic characteristics and delivery outcomes of different chorionic pregnant women in PE group and non-PE group were compared respectively. Univariate analysis and multivariate Logistic regression analysis were used to analyze the risk factors of preeclampsia in different chorionic twin pregnancies.

Results

The total incidence of PE in twin pregnancies was 10.4%， the incidence of PE in twin pregnancies from 2011 to 2019 varied between 7.8% and 11.8%. Regardless of MC and DC twin pregnancies， the incidence of anemia （MC： 58.2%

39.7%，

=0.010； DC： 59%

38%，

=0.000）， hypoproteinemia （MC： 7.3%

1.7%，

=0.035； DC： 10.5%

0.7%，

=0.000）， premature delivery （MC： 94.5%

70.1%，

=0.000； DC： 89.5%

54.8%，

=0.000）， postpartum hemorrhage （MC： 21.8%

10.6%，

=0.018； DC： 20.9%

13.4%，

=0.035）， neonatal transfer to intensive care unit （MC： 49.1%

28.6%，

=0.000； DC： 26.7%

15.6%，

=0.000） in pregnant women in PE group was higher than that in non-PE group， the difference between the two groups were statistically significant. the birth weight of both small fetuses and large fetuses in PE group of DC twins was lower than that in the non-PE group， the difference between these two groups were also statistically significant（

0.000；

=0.017）. Excessive weight gain during pregnancy and assisted reproductive technology for conception were independent risk factors for MC twin PE. Pre-pregnancy BMI≥24 kg/m

， excessive weight gain during pregnancy and excessive weight difference were independent risk factors for PE in DC twins.

Conclusions

The incidence of PE in twin pregnancies fluctuates between 7.8% and 11.8% in each year. The outcomes of PE in different chorionic twin pregnancy are slightly different. Excessive weight gain during pregnancy， assisted reproductive technology for conception， Pre-pregnancy BMI≥24 kg/m

and excessive weight difference of the twins during pregnancy are risk factors for PE in twin pregnancies， suggesting weight management during pregnancy is particularly important.

关键词

双胎妊娠子痫前期危险因素分娩结局

Keywords

twin pregnancypreeclampsiarisk factorsdelivery outcomes

references

杨宁，李玉明. 从指南变迁看妊娠期高血压疾病的诊治［J］. 中国实用内科杂志，2019， 39（1）： 23-26.

Yang N， Li YM. Diagnosis and treatment of hypertensive diseases in pregnancy from changes of guidelines ［J］. Chin J Pract Int Med， 2019， 39（1）： 23-26.

Laine K， Murzakanova G， Sole KB， et al. Prevalence and risk of pre-eclampsia and gestational hypertension in twin pregnancies： a population-based register study［J］. BMJ Open， 2019， 9（7）： e29908.

Martin JA， Hamilton BE， Ventura SJ， et al. Births： final data for 2011［J］. Natl Vital Stat Rep， 2013， 62（1）：1-69， 72.

张为远，杨孜. 妊娠期高血压疾病诊治指南（2020）［J］. 中华妇产科杂志， 2020， 55（4）： 227-238.

Zhang WY， Yang Z. Guidelines for the diagnosis and treatment of hypertensive disorders during pregnancy （2020）［J］. Chin J Obstet Gynecol， 2020， 55（4）： 227-238.

漆洪波，段涛. 妇产科学（9版）［M］. 北京：人民卫生出版社， 2018.

Qi HB， Duan T. Obstetrics and Gynecology（9th edition）［M］. Beijing： People′s Medical Publishing House， 2018.

王辰，葛均波，徐永健. 内科学（9版）［M］. 北京：人民卫生出版社， 2018.

Wang C， Ge JB， Xu YJ. Internal Medicine（9th edition）［M］. Beijing： People′s Medical Publishing House， 2018

杨慧霞，孙路明，段涛. 双胎妊娠临床处理指南（2020年更新）［J］. 中华围产医学杂志， 2020， 23（8）： 505-512.

Yang HX， Sun LM， Duan T. Guidelines for clinical management of twin pregnancy （2020 Update）［J］. Chin J Perinat Med， 2020， 23（8）： 505-512.

Rissanen AS， Jernman RM， Gissler M， et al. Maternal complications in twin pregnancies in Finland during 1987-2014： a retrospective study［J］. BMC Pregnancy and Childbirth， 2019， 19（1）： 337.

Khashan AS， Evans M， Kublickas M， et al. Preeclampsia and risk of end stage kidney disease： A Swedish nationwide cohort study［J］. PLoS Med， 2019， 16（7）： e1002875.

Sibai BM， Hauth J， Caritis S， et al. Hypertensive disorders in twin versus singleton gestations. national institute of child health and human development network of maternal-fetal medicine units［J］. Am J Obstet Gynecol， 2000， 182（4）： 938-942.

王茜，赵金珩，李娟，等. 外周血Hb及PLGF和PI联合检测对早发型子痫前期孕妇再妊娠的诊断价值［J］. 贵州医科大学学报， 2020， 45（1）： 67-71.

Wang Q， Zhao JH， Li J， et al. Diagnostic value of peripheral blood Hb， PLGF and PI combined for repregnancy in pregnant women with early preeclampsia［J］. J Guizhou Med Univ， 2020， 45（1）： 67-71.

Hou Y， Yun L， Zhang L， et al. A risk factor-based predictive model for new-onset hypertension during pregnancy in Chinese Han women［J］. BMC Cardiovasc Disord， 2020， 20（1）： 155.

Ananth CV， Chauhan SP. Epidemiology of twinning in developed countries［J］. Semin Perinatol， 2012， 36（3）： 156-161.

Queensland Clinical Guidelines. Preterm labour and birth. NoGuideline. MN20.6-V9-R25. Queensland Health［EB/OL］.（2020-06-30）［2021-01-08］. https：//www.health.qld.gov.au/qcg/publicationshttps://www.health.qld.gov.au/qcg/publications

Lucovnik M， Tul N， Verdenik I， et al. Risk factors for preeclampsia in twin pregnancies： a population-based matched case-control study［J］. J Perinat Med， 2012， 40（4）： 379-382.

Gavard JA， Artal R. Gestational weight gain and maternal and neonatal outcomes in term twin pregnancies in obese women［J］. Twin Res Hum Genet， 2014， 17（2）： 127-133.

Fox NS， Roman AS， Saltzman DH， et al. Risk factors for preeclampsia in twin pregnancies［J］. Am J Perinatol， 2014， 31（2）： 163-166.

耿小妍，郑薇，王腾等. 双胎妊娠孕期增重与围产结局的关系及适宜值探讨［J］. 中华围产医学杂志， 2019，（3）： 150-156.

Geng XY， Zheng W， Wang T，et al. Relationship between weight gain during pregnancy and perinatal outcome and its appropriate value ［J］. Chin J Perinat Med， 2019，（3）： 150-156.

王子莲，李珠玉. 妊娠期体质量管理与妊娠期高血压疾病［J］. 实用妇产科杂志， 2018， 34（4）： 251-253.

Wang ZL， Li ZY. Body quality management during pregnancy and hypertensive diseases during pregnancy ［J］. J Pract Obstet Gynecol， 2018， 34（4）： 251-253.

Lynch A， McDuffie RJ， Murphy J， et al. Preeclampsia in multiple gestation： the role of assisted reproductive technologies［J］. Obstet Gynecol， 2002， 99（3）： 445-451.

Klatsky PC， Delaney SS， Caughey AB， et al. The role of embryonic origin in preeclampsia： a comparison of autologous in vitro fertilization and ovum donor pregnancies［J］. Obstet Gynecol， 2010， 116（6）： 1387-1392.

Geisler ME， O′Mahony A， Meaney S， et al. Obstetric and perinatal outcomes of twin pregnancies conceived following IVF/ICSI treatment compared with spontaneously conceived twin pregnancies［J］. Eur J Obstet Gynecol Reprod Biol， 2014， 181： 78-83.

Wu DC， Huang LH， He ZM， et al. Preeclampsia in twin pregnancies： association with selective intrauterine growth restriction［J］. J Matern Fetal Neonatal Med， 2016， 29（12）： 1967-1971.

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