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Abstract：
BACKGROUND: The worldwide occurrence of triplet pregnancy is estimated to be 0.093%, with a natural incidence of approximately 1 in 8000. This study aims to analyze the neonatal health status and birth weight discordance (BWD) of triplets based on chorionicity from birth until discharge.
METHODS: This was a retrospective study. We reviewed a total of 136 triplet pregnancies at our tertiary hospital between January 1, 2001, and December 31, 2021. Maternal and neonatal outcomes, inter-triplet BWD, neonatal morbidity, and mortality were analyzed.
RESULTS: Among all cases, the rates of intrauterine death, neonatal death, and perinatal death were 10.29, 13.07, and 24.26%, respectively. Thirty-seven of the cases resulted in fetal loss, including 13 with fetal anomalies. The maternal complications and neonatal outcomes of the 99 triplet pregnancies without fetal loss were compared across different chorionicities, including a dichorionic (DC) group (41 cases), trichorionic (TC) group (37 cases), and monochorionic (MC) group (21 cases). Neonatal hypoproteinemia (P < 0.001), hyperbilirubinemia (P < 0.019), and anemia (P < 0.003) exhibited significant differences according to chorionicity, as did the distribution of BWD (P < 0.001). More than half of the cases in the DC and TC groups had a BWD < 15%, while those in the MC group had a BWD < 50% (47.6%). TC pregnancy decreased the risk of neonatal anemia (adjusted odds ratio [AOR] = 0.084) and need for blood transfusion therapy after birth (AOR = 0.119). In contrast, a BWD > 25% increased the risk of neonatal anemia (AOR = 10.135) and need for blood transfusion after birth (AOR = 7.127). TC pregnancy, MCDA or MCTA, and BWD > 25% increased neonatal hypoproteinemia, with AORs of 4.629, 5.123, and 5.343, respectively.
CONCLUSIONS: The BWD differed significantly according to chorionicity. Additionally, TC pregnancies reduced the risk of neonatal anemia and need for blood transfusion, but increased the risk of neonatal hypoproteinemia. In contrast, the BWD between the largest and smallest triplets increased the risk of neonatal anemia and the need for blood transfusion. TC pregnancy, MCDA or MCTA, and BWD > 25% increased the risks of neonatal hypoproteinemia. However, due to the limited number of triplet pregnancies, further exploration of the underlying mechanism is warranted.
METHODS: This was a retrospective study. We reviewed a total of 136 triplet pregnancies at our tertiary hospital between January 1, 2001, and December 31, 2021. Maternal and neonatal outcomes, inter-triplet BWD, neonatal morbidity, and mortality were analyzed.
RESULTS: Among all cases, the rates of intrauterine death, neonatal death, and perinatal death were 10.29, 13.07, and 24.26%, respectively. Thirty-seven of the cases resulted in fetal loss, including 13 with fetal anomalies. The maternal complications and neonatal outcomes of the 99 triplet pregnancies without fetal loss were compared across different chorionicities, including a dichorionic (DC) group (41 cases), trichorionic (TC) group (37 cases), and monochorionic (MC) group (21 cases). Neonatal hypoproteinemia (P < 0.001), hyperbilirubinemia (P < 0.019), and anemia (P < 0.003) exhibited significant differences according to chorionicity, as did the distribution of BWD (P < 0.001). More than half of the cases in the DC and TC groups had a BWD < 15%, while those in the MC group had a BWD < 50% (47.6%). TC pregnancy decreased the risk of neonatal anemia (adjusted odds ratio [AOR] = 0.084) and need for blood transfusion therapy after birth (AOR = 0.119). In contrast, a BWD > 25% increased the risk of neonatal anemia (AOR = 10.135) and need for blood transfusion after birth (AOR = 7.127). TC pregnancy, MCDA or MCTA, and BWD > 25% increased neonatal hypoproteinemia, with AORs of 4.629, 5.123, and 5.343, respectively.
CONCLUSIONS: The BWD differed significantly according to chorionicity. Additionally, TC pregnancies reduced the risk of neonatal anemia and need for blood transfusion, but increased the risk of neonatal hypoproteinemia. In contrast, the BWD between the largest and smallest triplets increased the risk of neonatal anemia and the need for blood transfusion. TC pregnancy, MCDA or MCTA, and BWD > 25% increased the risks of neonatal hypoproteinemia. However, due to the limited number of triplet pregnancies, further exploration of the underlying mechanism is warranted.
摘要：
背景：三胎妊娠的全球发生率估计为0.093％，自然发病率约为8000分之一。本研究旨在基于从出生到出院的绒毛膜性分析三胞胎的新生儿健康状况和出生体重不一致（BWD）。
方法：这是一项回顾性研究。我们在2001年1月1日至2021年12月31日期间在我们的三级医院共审查了136例三胎妊娠。孕产妇和新生儿结局，三元组间BWD，新生儿发病率，和死亡率进行了分析。
结果：在所有病例中，宫内死亡率,新生儿死亡,围产期死亡分别为10.29％、13.07％和24.26％，分别。其中37例导致胎儿丧失,包括13例胎儿异常.比较了99例没有胎儿丢失的三胎妊娠的产妇并发症和新生儿结局，包括双绒毛膜（DC）组（41例），三绒毛膜（TC）组（37例），单绒毛膜（MC）组（21例）。新生儿低蛋白血症(P<0.001),高胆红素血症（P<0.019），和贫血（P<0.003）根据绒毛膜的不同表现出显著差异，BWD的分布也是如此(P<0.001)。DC和TC组超过一半的病例BWD<15%，而MC组的BWD<50%(47.6%)。TC妊娠降低了新生儿贫血的风险（调整比值比[AOR]=0.084）和出生后需要输血治疗（AOR=0.119）。相比之下,aBWD>25%增加了新生儿贫血(AOR=10.135)和出生后需要输血(AOR=7.127)的风险。TC怀孕，MCDA或MCTA,BWD>25%增加新生儿低蛋白血症，AOR分别为4.629、5.123和5.343。
结论：BWD根据绒毛膜的不同而存在显著差异。此外,TC怀孕降低了新生儿贫血的风险和输血的需要，但增加了新生儿低蛋白血症的风险。相比之下,最大和最小三胞胎之间的BWD增加了新生儿贫血的风险和输血的需要.TC怀孕，MCDA或MCTA,BWD>25%增加了新生儿低蛋白血症的风险。然而,由于三胞胎怀孕的数量有限，需要进一步探索潜在的机制。
方法：这是一项回顾性研究。我们在2001年1月1日至2021年12月31日期间在我们的三级医院共审查了136例三胎妊娠。孕产妇和新生儿结局，三元组间BWD，新生儿发病率，和死亡率进行了分析。
结果：在所有病例中，宫内死亡率,新生儿死亡,围产期死亡分别为10.29％、13.07％和24.26％，分别。其中37例导致胎儿丧失,包括13例胎儿异常.比较了99例没有胎儿丢失的三胎妊娠的产妇并发症和新生儿结局，包括双绒毛膜（DC）组（41例），三绒毛膜（TC）组（37例），单绒毛膜（MC）组（21例）。新生儿低蛋白血症(P<0.001),高胆红素血症（P<0.019），和贫血（P<0.003）根据绒毛膜的不同表现出显著差异，BWD的分布也是如此(P<0.001)。DC和TC组超过一半的病例BWD<15%，而MC组的BWD<50%(47.6%)。TC妊娠降低了新生儿贫血的风险（调整比值比[AOR]=0.084）和出生后需要输血治疗（AOR=0.119）。相比之下,aBWD>25%增加了新生儿贫血(AOR=10.135)和出生后需要输血(AOR=7.127)的风险。TC怀孕，MCDA或MCTA,BWD>25%增加新生儿低蛋白血症，AOR分别为4.629、5.123和5.343。
结论：BWD根据绒毛膜的不同而存在显著差异。此外,TC怀孕降低了新生儿贫血的风险和输血的需要，但增加了新生儿低蛋白血症的风险。相比之下,最大和最小三胞胎之间的BWD增加了新生儿贫血的风险和输血的需要.TC怀孕，MCDA或MCTA,BWD>25%增加了新生儿低蛋白血症的风险。然而,由于三胞胎怀孕的数量有限，需要进一步探索潜在的机制。
