Chinese Medical E-ournals Database
Adv Search
中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2022, Vol. 18 ›› Issue (01): 102 -110. doi: 10.3877/cma.j.issn.1673-5250.2022.01.014

Original Article

Birthweight discordance of twin newborns on their risk of complications

Ling Yang1,1, Beibei Wang2,2, Yan Zhou1,1, Jing Su1,1, Ning Gu1,1, Beibei Bu1,1, Yimin Dai1,1,†()   

  • Received:2021-01-04 Revised:2021-11-01 Published:2022-02-01
  • Corresponding author: Yimin Dai
  • Supported by:
    Construction Unit of Jiangsu Obstetrics Clinical Medicine Center (Innovation Platform)(2016-17)
HTML ( ) PDF ( )
Objective

To explore clinical significance of birthweight discordance of twin newborns (ΔBW) in predicting their complications.

Methods

From January 2018 to December 2019, a retrospective study was conducted on 752 pairs of twins (1 504 cases) who delivered in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, and among them one of the twins not transferred to neonatal intensive care unit (NICU) for at least one case. According to whether one of twin newborns had complications, they were divided into study group (n=178) and control group (n=574). According to whether one of twins in study group was transferred to NICU, it was further divided into NICU subgroup (n=153) and non-NICU subgroup (n=25). Methods of single-factor analysis and multi-factor unconditional logistics regression analysis were performed on risk factors of twin newborn complications, and receiver operating characteristic (ROC) curve for predicting the total risk factors of twin newborn complications was drawn. The procedure followed in this study met the requirements of the Helsinki Declaration of the World Medical Association revised in 2013, and had been reviewed and approved by the Ethics Committee of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School (Approval No. 2020-264).

Results

①Among 752 pairs of twins, one of 178 pairs of twins had complications, the incidence rate was 23.7% (178/752). ② The cesarean section rate, assisted reproduction rate, gestational age, birth weight and Apgar score of twins in study group were lower than those in control group, while the proportion of pregnancy-induced hypertension, monochorionic(MC) twin pregnancies and birth weight of one twin <P10 or <P3, ΔBW and rate of transfer to NICU in study group were significantly higher than those in control group, and the differences between two groups were statistically significant (P<0.05). ③ The gestational age, birth weight, Apgar score of twins in NICU subgroup were lower than those in non-NICU subgroup, and the differences were statistically significant (P<0.05). ④The multivariate unconditional logistics regression analysis showed that cesarean section (OR=0.246, 95%CI: 0.145-0.418, P<0.001) and gestational age<37 weeks (OR=22.294, 95%CI: 10.884-45.666, P<0.001), umbilical blood flow abnormality in either fetus (OR=2.879, 95%CI: 1.183-7.004, P=0.020), birth weight in either fetus <P3 (OR=3.384, 95%CI: 1.598-7.164, P=0.001) were independent influencing factors of twin newborn complications. Hierarchical analysis of ΔBW showed that 20%≤ΔBW<30% (OR=4.799, 95%CI: 2.612-8.814, P<0.001) and ΔBW≥30% (OR=15.984, 95%CI: 4.36-58.475, P<0.001) were also independent risk factors of twin newborn complications. ⑤ The area under curve (AUC) of ΔBW combined with birth weight of one of twin<P3 to predict risk of complications of twin newborns was 0.666 (95%CI: 0.577-0.755, P<0.001), and the sensitivity and specificity were 57.1% and 81.9%, respectively. The AUC of ΔBW combined with abnormal umbilical blood flow in predicting risk of complications of twin newborns was 0.714 (95%CI: 0.632-0.797, P<0.001), and the sensitivity and specificity were 61.9% and 79.8%, respectively.

Conclusions

ΔBW is associated with an increased risk of twin newborn complications. Paying attention to ΔBW combined with prenatal fetal blood flow monitoring are of great significance to establish an effective risks screening process for twins.

Key words: Birthweight, Twins, Birthweight discordance, Neonatal prognosis, Neonatal morbidity, Twin pregnancies
表1 影响2组双胎新生儿之一并发症发生因素的单因素分析结果
组别 例数 产妇
年龄(岁，±s) 孕次[次，M(P25~P75)] 产次[次，M(P25~P75)] 剖宫产术分娩[例数(%)] 单绒毛膜双胎[例数(%)] 辅助生殖受孕[例数(%)] HDCP[例数(%)]
研究组 178 30.1±4.3 1.0(1.0~2.0) 1.0(1.0~1.0) 135(75.8) 56(31.5) 89(50.0) 57(32.0)
对照组 574 30.5±4.0 1.0(1.0~2.0) 1.0(1.0~1.0) 524(91.3) 132(23.0) 364(63.4) 104(18.1)
检验值   t＝-1.422 Z＝-1.000 Z＝-0.332 χ2＝29.912 χ2＝5.191 χ2＝10.208 χ2＝15.611
P值   0.155 0.741 0.921 <0.001 0.023 0.001 <0.001
组别 例数 产妇 双胎新生儿
GDM[例数(%)] 双胎之一脐血流异常[%(n/n′)]a 生后1 min Apgar评分(分，±s) 生后5 min Apgar评分(分，±s) 双胎之一转入NICU[例数(%)] 双胎之一新生儿死亡[例数(%)] 出生胎龄(周，±s)
研究组 178 30(16.9) 42.9(27/63) 8.3±1.0 9.0±1.2 153(86.0) 9(5.1) 33.7±2.3
对照组 574 93(16.2) 11.2(21/188) 8.9±0.4 9.9±0.4 23(4.0) 0(0) 36.6±1.8
检验值   χ2＝0.042 χ2＝30.633 t＝-10.190 t＝-12.909 χ2＝508.971 χ2＝29.374 t＝-16.562
P值   0.837 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
组别 例数 双胎新生儿
出生体重(g，±s) 双胎之一出生体重<P3[例数(%)] 双胎之一出生体重<P10[例数(%)] ΔBW(%，±s) 10%≤ΔBW<20%[例数(%)] 20%≤ΔBW<30%[例数(%)] ΔBW≤30%[例数(%)]
研究组 178 1 890.1±519.5 43(24.2) 77(43.3) 16.9±12.6 39(21.9) 44(24.7) 26(14.6)
对照组 574 2 598.1±334.2 51(8.9) 181(31.5) 9.7±7.4 184(32.1) 46(8.0) 5(0.9)
检验值   t＝-26.008 χ2＝28.974 χ2＝8.288 t＝6.955 χ2＝6.704 χ2＝35.990 χ2＝64.860
P值   <0.001 <0.001 0.004 <0.001 0.010 <0.001 <0.001
表2 研究组双胎新生儿之一转入NICU影响因素的单因素分析结果
组别 例数 产妇
年龄(岁，±s) 孕次[次，M(P25~P75)] 产次[次，M(P25~P75)] 剖宫产术分娩[例数(%)] MC[例数(%)] 辅助生殖[例数(%)] HDCP[例数(%)]
NICU亚组 153 30.1±4.4 1.0(1.0~2.0) 1.0(1.0~2.0) 112(73.2) 49(32.0) 79(51.6) 53(34.6)
非NICU亚组 25 29.9±3.8 1.0(1.0~2.5) 1.0(1.0~2.0) 23(92.0) 7(27.0) 11(44.0) 4(16.0)
检验值   t＝0.261 Z＝-0.039 Z＝-0.093 χ2＝3.182 χ2＝0.162 χ2＝0.501 χ2＝2.627
P值   0.795 0.969 0.926 0.074 0.688 0.479 0.105
组别 例数 产妇 双胎新生儿
GDM[例数(%)] 双胎之一脐血流异常[%(n/n′)]a 生后1 min Apgar评分(分，±s) 生后5 min Apgar评分(分，±s) 双胎之一新生儿死亡[例数(%)] 胎龄(周，±s)
NICU亚组 153 30(19.6) 44.1(26/59) 8.3±1.1 9.0±1.2 9(5.9) 33.3±2.2
非NICU亚组 25 1(4.0) 25.0(1/4) 8.8±0.4 9.5±1.1 0(0) 36.3±1.0
检验值   χ2＝2.635 χ2＝0.050 t＝-6.467 t＝-3.448 χ2＝0.566 t＝-10.877
P值   0.105 0.823 <0.001 0.001 0.456 <0.001
组别 例数 双胎新生儿
出生体重(g，±s) 双胎之一出生体重<P3[例数(%)] 双胎之一出生体重<P10[例数(%)] ΔBW(%，±s) 10%≤ΔBW<20%[例数(%)] 20%≤ΔBW<30%[例数(%)] ΔBW≤30%[例数(%)]
NICU亚组 153 1 804.8±443.7 36(23.5) 64(41.8) 17.3±13.5 35(22.9) 34(22.2) 26(17.0)
非NICU亚组 25 2 412.0±337.5 7(28.0) 13(52.0) 14.1±10.3 4(16.0) 10(40.0) 0(0)
检验值   t＝-11.233 χ2＝0.234 χ2＝0.905 t＝1.391 χ2＝0.260 χ2＝5.640 χ2＝3.706
P值   <0.001 0.628 0.341 0.172 0.610 0.056 0.054
表3 双胎新生儿之一并发症的多因素logistics回归分析变量含义及其赋值情况
自变量/因变量 变量名 赋值
新生儿是否发生并发症 y y＝0表示双胎新生儿均未发生并发症，y＝1表示双胎之一发生并发症
剖宫产术分娩 x1 x1＝0表示自然分娩，x1＝1表示剖宫产术分娩
MC x2 x2＝0表示双绒毛膜，x2＝1表示MC
胎龄<37周 x3 x3＝0表示胎龄≥37周，x3＝1表示胎龄<37周
双胎之一脐血流异常 x4 x4＝0表示脐血流正常，x4＝0表示双胎之一有脐血流异常
双胎之一出生体重<P3 x5 x5＝0表示双胎出生体重<P3，x5＝1表示双胎之一出生体重<P3
10%≤ΔBW<20% x6 x6＝0表示ΔBW<10%或≥20%，x6＝1表示10%≤ΔBW<20%
20%≤ΔBW<30% x7 x7＝0表示ΔBW<20%或≥30%，x7＝1表示20%≤ΔBW<30%
ΔBW≥30% x8 x8＝0表示ΔBW<30%，x8＝1表示ΔBW≥30%
表4 双胎新生儿之一总体并发症的多因素非条件logistics回归分析
影响因素 B SE Wald值 P值 OR值 OR值95%CI
剖宫产术分娩 -1.403 0.271 26.839 <0.001 0.246 0.145~0.418
MC -0.180 0.230 0.609 0.435 0.836 0.532~1.312
胎龄<37周 3.104 0.366 72.004 <0.001 22.294 10.884~45.666
双胎之一脐血流异常a 1.057 0.454 5.431 0.020 2.879 1.183~7.004
双胎之一出生体重<P3 1.219 0.383 10.148 0.001 3.384 1.598~7.164
10%≤ΔBW<20% -0.058 0.251 0.053 0.817 0.944 0.577~1.544
20%≤ΔBW<30% 1.568 0.310 25.557 <0.001 4.799 2.612~8.814
ΔBW≥30% 2.772 0.662 17.542 <0.001 15.984 4.369~58.475
常数项 -2.828 0.416 46.308 <0.001 0.059 —
图1 ΔBW、双胎新生儿之一出生体重<P3、脐血流异常预测双胎新生儿之一总体并发症的ROC曲线(图1A：ΔBW、双胎新生儿之一出生体重<P3及ΔBW联合双胎新生儿之一出生体重<P3预测并发症的ROC曲线；图1B：ΔBW、胎儿脐血流异常及ΔBW联合胎儿脐血流异常预测251对有胎儿脐血流检查结果双胎新生儿之一总体并发症的ROC曲线)注：ΔBW为双胎出生体重差值，P3为双胎新生儿之一出生体重小于同胎龄儿第3百分位数，ROC曲线为受试者工作特征曲线
[1]
万燕南，程茜. 双胎生长不一致的成因与结局研究进展[J]. 现代医药卫生， 2019, 35(19): 2999-3002. DOI: 10.3969/j.issn.1009-5519.2019.19.019.
[2]
陈楠，温晓红，黄金华，等．影响极低出生体重儿远期神经发育结局的相关因素[J]．中华围产医学杂志，2016，19(3): 219-221. DOI: 10.3760/ema.j.issn.1007-9408.2016.03.01.
[3]
王永明，韦红．早产儿预后研究进展[J/CD]．中华产科急救电子杂志，2018, 7(4): 236-240. DOI: 10.3877/cma.j.issn.2095-3259.2018.04.010.
[4]
Hehir MP, Breathnach FM, Hogan JL, et al. Prenatal prediction of significant intertwin birthweight discordance using standard second and third trimester sonographic parameters[J]. Acta Obstet Gynecol Scand, 2017, 96: 472-478. DOI: 10.1111/aogs.13092.
[5]
Vedel C, Oldenburg A, Worda K, et al. Short- and long-term perinatal outcome in twin pregnancies affected by weight discordance[J]. Acta Obstet Gynecol Scand, 2017, 96(2): 233-242. DOI: 10.1111/aogs.13062.
[6]
D′Antonio F, Thilaganathan B, Laoreti A, et al. Birth-weight discordance and neonatal morbidity in twin pregnancy: analysis of STORK multiple pregnancy cohort[J]. Ultrasound Obstet Gynecol, 2018, 52(5): 586-592. DOI: 10.1002/uog.18916.
[7]
Di′ Mascio D, Acharya G, Khalil A, et al. Birthweight discordance and neonatal morbidity in twin pregnancies: a systematic review and Meta-analysis[J]. Acta Obstet Gynecol Scand, 2019, 98(10): 1245-1257. DOI: 10.1111/aogs.13613.
[8]
Jon B. The SOGC consensus conference on twin pregnancies[J]. J SOGC, 2000, 22(7): 491-492. DOI: 10.1016/s0849-5831(16)30127-6.
[9]
Khalil A, Rodgers M, Baschat A, et al. ISUOG practice guidelines: role of ultrasound in twin pregnancy[J]. Ultrasound Obstet Gynecol, 2016, 47(2): 247-263. DOI: 10.1002/uog.15821.
[10]
中华医学会妇产科学分会妊娠期高血压疾病学组. 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. DOI: 10.3760/cma.j.cn112141-20200114-00039.
[11]
中华医学会妇产科学分会产科学组， 中华医学会围产医学分会妊娠合并糖尿病协作组. 妊娠合并糖尿病诊治指南(2014)[J]. 中华妇产科杂志，2014，49 (8): 561-569. DOI: 10.3760/cma.j.issn.0529-567X.2014.08.001.
[12]
邵肖梅， 叶鸿瑁， 丘小汕. 实用新生儿学[M]. 4版. 北京： 人民卫生出版社， 2011: 222-590.
[13]
中华医学会围产医学分会胎儿医学学组，中华医学会妇产科学分会产科学组. 胎儿生长受限专家共识(2019版)[J]. 中华围产医学杂志， 2019, 22(6): 361-380. DOI：10.3760/cma.j.issn.1007-9408.2019.06.001.
[14]
中华医学会围产医学分会胎儿医学学组， 中华医学会妇产科学分会产科学组. 双胎妊娠临床处理指南(第一部分)：双胎妊娠的孕期监护及处理[J]. 中华妇产科杂志， 2015, 50(8): 561-567. DOI: 10.3760/cma.j.issn.0529-567x.2015.08.001.
[15]
张丽， 董彦会， 马军. 新生儿双胎体重不均衡的现状及其危险因素分析[J]. 中国新生儿科杂志，2016, 31(6): 439-441. DOI: 10.3969/j.issn.16736710.2016.06.009.
[16]
National Collaborating Centre for Women′s and Children′s Health (UK). Multiple pregnancy: the management of twin and triplet pregnancies in the antenatal period[M]. London: RCOG Press, 2011.
[17]
American College of Obstetricians and Gynecologists Committee on Practice Bulletins-Obstetrics, Society for Maternal-Fetal Medicine, ACOG Joint Editorial Committee. ACOG Practice Bulletin #56: Multiple gestation: complicated twin, triplet, and high-order multifetal pregnancy[J]. Obstet Gynecol，2004，104(4)：869-883. DOI: 10.1097/00006250-200410000-00046.
[18]
Fumagalli M, Schiavolin P, Bassi L, et al. The impact of twin birth on early neonatal outcomes[J]. Am J Perinatol，2016，33(1)：63-70. DOI: 10.1055/s-0035-1556881.
[19]
D′Antonio F, Odibo AO, Prefumo F, et al. Weight discordance and perinatal mortality in twin pregnancy: systematic review and meta-analysis[J]. Ultrasound Obstet Gynecol，2018，52(1)：11-23. DOI: 10.1002/uog.18966.
[20]
Breathnach FM, McAuliffe FM, Geary M, et al. Definition of intertwin birth weight discordance[J]. Obstet Gynecol，2011，118(1)：94-103.
[21]
陈倩．胎儿脐血流与大脑中动脉血流的超声监测[J/CD]. 中华产科急救电子杂志， 2018, 7(4) : 250-252.DOI: 10.3877/cma.j.issn.2095-3259.2018.04.014.
[22]
Buca D, Pagani G, Rizzo G, et al. Outcome of monochorionic twin pregnancy with selective intrauterine growth restriction according to umbilical artery Doppler flow pattern of smaller twin: systematic review and meta-analysis[J]. Ultrasound Obstet Gynecol, 2017, 50(5): 559-568. DOI: 10.1002/uog.17362.
[23]
Khalil A, Beune I, Hecher K, et al. Consensus definition and essential reporting parameters of selective fetal growth restriction in twin pregnancy: a Delphi procedure[J]. Ultrasound Obstet Gynecol, 2019, 53(1): 47-54. DOI: 10.1002/ijgo.13017.
[24]
Algeri P, Frigerio M, Lamanna M, et al. Selective IUGR in dichorionic twins: what can Doppler assessment and growth discordancy say about neonatal outcomes？[J]. J Perinat Med, 2018, 46(9): 1028-1034. DOI: 10.1515/jpm-2017-0253.
[25]
Monaghan C, Kalafat E, Binder J, et al. Prediction of adverse pregnancy outcome in monochorionic diamniotic twin pregnancy complicated by selective fetal growth restriction[J]. Ultrasound Obstet Gynecol, 2019, 53(2): 200-207. DOI: 10.1002/uog.19078.
[26]
王海红， 韩冰， 张慧. 影响超声估计胎儿体重准确性因素的研究进展[J]. 中华围产医学杂志， 2018, 21(10): 706-711. DOI: 10.3760/cma.j.issn.1007-9408.2018.10.012.
[1] Li Lu, Xiaohong Yang, Sheng Zhao, Xinlin Chen. Ultrasonographic and pathological characteristics of twin reversed-arterial perfusion sequence[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(06): 426-432.
[2] Jiajia Chen, Congying Chen, Shengli Li, Ying Yuan, Huaxuan Wen, Jingru Bi, Yong Guan, Meiyu Zheng. Antepartum ultrasonographic diagnosis of conjoined twins in early pregnancy[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2018, 15(08): 605-611.
[3] Aiqing Zhang, Yuan Wei, Chunyu Zhang, Zhaohui Liu, Lijun Gong, Wei Wang, Ping Li, Shan Lu, Chun Tong, Yiwen Chong. The comparative analysis of prenatal ultrasonographic features and clinical outcome of a twin pregnancy consisting of a complete mole and coexisting fetus[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(08): 603-608.
[4] Zixian Li, Xianghong Li, Mengya Sun, Liangliang Li, Xiangyun Yin, Hongmin Xi, Ping Yang, Lili Ma. Clinical characteristics of neonatal necrotizing enterocolitis in preterm monochorionic twins: two cases report and literature review[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2022, 18(03): 343-349.
[5] Xuan Yang, Jun Tang. Current status of diagnosis and treatment of twin-twin transfusion syndrome and its influence on prognosis of neonates[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2020, 16(05): 510-518.
[6] Shaodong Hua, Zhenhui Zhou, Shumei Wang, Jia Chen, Yabo Mei, Qiuping Li, Zhichun Feng. Hemolytic anemia due to unrelated umbilical cord blood stem cell transplantation for extreme premature infants bronchopulmonary dysplasia and literature review[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2020, 16(02): 202-208.
[7] Fenfang Peng, Xiaoyan Yang, Jing Shi, Dapeng Chen, Ying Xiong. Twin anemia-polycythemia sequence: a case report and literatures review[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2019, 15(01): 73-80.
[8] Ying Xu, Jing Lu, Yuanzhen Zhang, Li Lin. Prenatal ultrasound diagnosis of conjoined twins and literatures review[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2018, 14(05): 515-520.
[9] Huan Zhang, Hongju He, Min Xu, Jie Chen, Haiyan Yu. Prognosis of twin-twin transfusion syndrome[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2017, 13(02): 139-143.
[10] Feifei Wang, Shiqiao Tan, Xiaodong Wang, Haiyan Yu. Ductus venosus blood flow spectrum of ultrasonic testing in perinatal period[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2017, 13(02): 131-134.
[11] Min Xia, Ping Yang, Wei Cui, Lei Li, Haining Wang, Rengui Quan, Yuchun Song, Aiqun Xu. Clinical characteristics of twin pregnancy complicated with preterm birth and analysis of preterm infants′ outcomes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2016, 12(05): 590-596.
[12] Linhuan Huang, Yi Zhang, Shaobin Lin, Jianzhu Wu, Qun Fang, Zilian Wang. Prenatal diagnosis of one of the monochorionic diamniotic twins with congenital heart disease[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2019, 08(01): 38-44.
[13] Han Zhang, Yangyu zhao. Apllication of radiofrequency ablation and fetal reduction in complicated twin pregnancy[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2019, 08(01): 10-13.
[14] Shuai Hang, Hongbo Qi. Diagnosis and treatment of single intrauterine fetal death[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2019, 08(01): 5-9.
[15] Yihong Luo, Huishu Liu. Management of vaginal delivery in twin pregnancy[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2018, 07(03): 162-165.
Viewed
Full text


Abstract

Copyright © Chinese Medical Association, Chinese Medical Multimedia Press  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号