目的:评估双胎妊娠中用于基因筛查的血清分析物与产科并发症之间的关联。
方法:该队列包括2009年至2017年在三级护理医院分娩的双胞胎。妊娠相关血浆蛋白(PAPP-A)水平异常,孕早期和中期人绒毛膜促性腺激素(hCG),甲胎蛋白(AFP),雌三醇,还有抑制素,报告为中位数(MoM)的倍数,对于我们的队列,定义为<5%ile或>95%ile。异常分析物和早产之间的关联,小于胎龄,使用Fisher精确检验计算妊娠相关高血压。
结果:共包括357对双胎/双胎和123对单胎/双胎。在双绒毛膜/羊膜双胞胎中,AFP升高(>3.70MoM)与34周以下早产增加相关(44.4vs.16.5%,p=0.007),而升高的抑制素(>4.95MoM)与早产<37周增加相关(94.1vs.58.8%,p=0.004)。对于单绒毛膜/羊膜双胞胎,抑制素升高(>6.34MoM)与早产<34周相关(66.7vs.24.8%,p=0.04)和高血压(66.7vs.21.4%,p=0.03)。
结论:选定的异常分析物水平与双胎妊娠不良结局发生率增加相关,不同的是绒毛膜。我们的发现有助于提供者解释双胎妊娠中异常的分析物水平,并可能有助于识别那些不良结局风险增加的人。
OBJECTIVE: To evaluate associations between serum analytes used for genetic screening and obstetric complications among twin pregnancies.
METHODS: This cohort included twins delivered at a tertiary care hospital from 2009 to 2017. Abnormal levels of pregnancy associated plasma protein (PAPP-A), first and second trimester human chorionic gonadotropin (hCG), alpha fetoprotein (AFP),
estriol, and inhibin, reported as multiples of the median (MoM), were defined as <5 %ile or >95 %ile for our cohort. Associations between abnormal analytes and preterm delivery, small for gestational age, and pregnancy-associated hypertension were calculated using Fisher\'s exact test.
RESULTS: A total of 357 dichorionic/diamniotic and 123 monochorionic/diamniotic twins were included. Among dichorionic/diamniotic twins, elevated AFP (>3.70 MoM) was associated with increased preterm delivery <34 weeks (44.4 vs. 16.5 %, p=0.007), while elevated inhibin (>4.95 MoM) was associated with increased preterm delivery<37 weeks (94.1 vs. 58.8 %, p=0.004). For monochorionic/diamniotic twins, elevated inhibin (>6.34 MoM) was associated increased preterm delivery <34 weeks (66.7 vs. 24.8 %, p=0.04) and hypertension (66.7 vs. 21.4 %, p=0.03).
CONCLUSIONS: Selected abnormal analyte levels were associated with increased rates of adverse outcomes in twin pregnancies, which differed by chorionicity. Our findings assist providers in interpreting abnormal analyte levels in twin pregnancies and may help to identify those at increased risk for adverse outcomes.