背景:适当的妊娠期体重增加(GWG)对于母体和胎儿的健康至关重要。对于白人女性的双胎妊娠,医学研究所(IOM)指南可用于监测和指导GWG。我们旨在从外部验证和比较IOM指南和最近发布的中国双胎妊娠妇女指南关于其建议对总GWG(TGWG)的适用性。
方法:2016年10月至2020年6月期间,在广州对年龄在18-45岁并在≥26孕周分娩双胞胎的1534名妇女进行了回顾性队列研究。中国。妇女的TGWG被归类为不足,最优,以及根据国际移民组织和中国指南的超额。使用多变量广义估计方程逻辑回归来估计TGWG类别与不良新生儿结局之间的风险关联。计算Cohen的Kappa系数以评估IOM与中国指南之间的一致性。
结果:由国际移民组织或中国指南定义,TGWG不足的女性,与具有最佳TGWG的那些相比,显示小于胎龄出生和新生儿黄疸的风险较高,而TGWG过多的女性分娩胎龄较大的婴儿的风险较高.两个指南之间的一致性相对较高(Kappa系数=0.721)。与两组指南中的最佳TGWG组相比,根据中国指南被划分为最佳组,但根据IOM指南被划分为不适当组的女性(n=214)显示,所有不良新生儿结局合并风险均无统计学显著增加.
结论:IOM和中国指南均适用于中国双胎妊娠妇女。
Appropriate gestational weight gain (GWG) is essential for maternal and fetal health. For twin pregnancies among Caucasian women, the Institute of Medicine (IOM)
guidelines can be used to monitor and guide GWG. We aimed to externally validate and compare the IOM
guidelines and the recently released
guidelines for Chinese women with twin pregnancies regarding the applicability of their recommendations on total GWG (TGWG).
A retrospective cohort study of 1534 women who were aged 18-45 years and gave birth to twins at ≥ 26 gestational weeks between October 2016 and June 2020 was conducted in Guangzhou, China. Women\'s TGWG was categorized into inadequate, optimal, and excess per the IOM and the Chinese guidelines. Multivariable generalized estimating equations logistic regression was used to estimate the risk associations between TGWG categories and adverse neonatal outcomes. Cohen\'s Kappa coefficient was calculated to evaluate the agreement between the IOM and the Chinese guidelines.
Defined by either the IOM or the Chinese guidelines, women with inadequate TGWG, compared with those with optimal TGWG, demonstrated higher risks of small-for-gestational-age birth and neonatal jaundice, while women with excess TGWG had a higher risk of delivering large-for-gestational-age infants. The agreement between the two
guidelines was relatively high (Kappa coefficient = 0.721). Compared with those in the optimal TGWG group by both sets of the guidelines, women classified into the optimal group by the Chinese
guidelines but into the inadequate group by the IOM
guidelines (n = 214) demonstrated a statistically non-significant increase in the risk of all the adverse neonatal outcomes combined.
The IOM and the Chinese
guidelines are both applicable to Chinese women with twin pregnancies.