PDF(Pubmed)
Abstract：
The prevalence of overweight and obese people worldwide has dramatically increased in the last decades and is yet to peak. At the same time and partly due to obesity and associated assisted reproduction, twinning rates showed a clear rise in the last years. Adverse fetomaternal outcomes are known to occur in singleton and twin pregnancies in overweight and obese women. However, the impact of the obesity levels as defined by the World Health Organization on the outcomes of twin pregnancies has not been thoroughly studied. Therefore, the purpose of this study is to examine how maternal overweight, and the level of obesity affect fetomaternal outcomes in twin pregnancies, hypothesizing a higher likelihood for adverse outcomes with overweight and each obesity level. This is a retrospective cohort study with 2,349 twin pregnancies that delivered at the Buergerhospital Frankfurt, Germany between 2005 and 2020. The mothers were divided into exposure groups depending on their pre-gestational body mass index; these were normal weight (reference group), overweight and obesity levels I, II, and III. A multivariate logistic regression analysis was performed to assess the influence of overweight and obesity on gestational diabetes mellitus, preeclampsia, postpartum hemorrhage, intrauterine fetal death, and a five-minutes Apgar score below seven. The adjusted odds ratio for gestational diabetes compared to normal weight mothers were 1.47, 2.79, 4.05, and 6.40 for overweight and obesity levels I, II and III respectively (p = 0.015 for overweight and p < 0.001 for each obesity level). Maternal BMI had a significant association with the risk of preeclampsia (OR 1.04, p = 0.028). Overweight and obesity did not affect the odds of postpartum hemorrhage, fetal demise, or a low Apgar score. While maternal overweight and obesity did not influence the fetal outcomes in twin pregnancies, they significantly increased the risk of gestational diabetes and preeclampsia, and that risk is incremental with increasing level of obesity.
摘要：
在过去的几十年中，全球超重和肥胖人群的患病率急剧增加，并且尚未达到峰值。同时，部分由于肥胖和相关的辅助生殖，孪生率在过去几年中显示出明显的上升。众所周知，超重和肥胖妇女的单胎和双胎妊娠会发生胎儿不良结局。然而,世界卫生组织定义的肥胖水平对双胎妊娠结局的影响尚未得到彻底研究.因此,这项研究的目的是研究孕妇超重，肥胖水平影响双胎妊娠的胎儿结局，假设超重和每个肥胖水平出现不良结局的可能性较高.这是一项回顾性队列研究，在法兰克福Buergerhospital分娩的2,349例双胎妊娠，德国在2005年至2020年之间。根据孕前体重指数将母亲分为暴露组；这些是正常体重（参考组），超重和肥胖水平I，II,和III。进行了多因素logistic回归分析，以评估超重和肥胖对妊娠期糖尿病的影响。先兆子痫,产后出血,胎儿宫内死亡，五分钟阿普加得分低于7分.对于超重和肥胖水平I，与正常体重母亲相比，妊娠期糖尿病的调整比值比分别为1.47、2.79、4.05和6.40。II和III分别（超重时p=0.015，每个肥胖水平p<0.001）。孕妇BMI与先兆子痫风险有显著关联(OR1.04,p=0.028)。超重和肥胖并不影响产后出血的几率，胎儿死亡,或者阿普加分数很低.虽然孕妇超重和肥胖不会影响双胎妊娠的胎儿结局，它们显著增加了妊娠糖尿病和先兆子痫的风险，这种风险随着肥胖程度的增加而增加。
