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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 (04): 400 -409. doi: 10.3877/cma.j.issn.1673-5250.2022.04.005

Original Article

Risk factors of perinatal outcomes of surviving baby after vanishing twin syndrome

Lu Zhang, Huijuan Yang, Kaibo Liu†()   

  1. Department of Perinatal Health Care, Beijing Obstetrics and Gynecology Hospital, Capital Medical University/Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
  • Received:2022-05-11 Revised:2022-07-14 Published:2022-08-01
  • Corresponding author: Kaibo Liu
  • Supported by:
    Special Project of Capital Health Development and Research(2018-2-2111)
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Objective

To explore perinatal outcomes of surviving baby after vanishing twin syndrome (VTS) and its risk factors.

Methods

A total of 155 560 babies of single delivered in Beijing from January 1, to December 31, 2020 were selected as research subjects. The pregnant mothers underwent early pregnancy ultrasound examinations and their pregnancy outcomes were registered in the Beijing Maternal and Child Health Information Network System. Surviving babies after VTS (hereinafter referred to as survivors) were included into study group (n=381), and those singletons pregnancy (hereinafter referred to as singletons) were included into control group (n=155 179), according to whether mother was twin pregnancy or not by retrospective study method. According to fertilization method, babies in study group and control group were further divided into N study subgroup (n=187, natural fertilization) and A study subgroup [n=194, by assisted reproductive technology (ART)], N control subgroup (n=149 900, natural fertilization) and A control subgroup (n=5 279, by ART). Independent-samples t test, chi-square test, continuity-corrected chi-square test and Fisher probabilities test were used for statistical comparison of babies between study group and control group and their subgroups about incidences of preterm birth, low birth weight, full-term small for gestational age infant, perinatal death, birth defects and other perinatal outcomes, and clinical data of their pregnant mothers. Multivariate unconditional logistic regression analysis was used to analyze the influencing factors of perinatal outcomes of all babies. There were no significant differences in general clinical data such as gender composition between study group and control group (P>0.05). The procedures followed in this study complied with the regulations of the Medical Ethics Committee of Beijing Obstetrics and Gynecology Hospital, Capital Medical University/Beijing Maternal and Child Health Hospital, and were approved by the ethics committee (Approval No. 2018-KY-039-01).

Results

①The incidences of preterm birth <34 weeks, preterm birth <37 weeks, low birth weight (<2 500 g), full-term small for gestational age infant and birth defects in study group, A study subgroup, B study subgroup all were significantly higher than those in control group, A control subgroup, B control subgroup, respectively, and all differences were statistically significant (P<0.05). There were no significant differences of babies between study group and control group and their subgroups in perinatal mortality (P>0.05). ②The rate of pregnant mothers ≥35-year old, first pregnancy, primipara, ART conception, adverse pregnancy history, uterine abnormalities, regular use of folic acid from 3 months before pregnancy to the first trimester, delivery in a grade-A tertiary midwifery institution, hypertension in pregnancy and cesarean section delivery in study group were significantly higher than those in control group, and all differences were statistically significant (P<0.001). ③Multivariate unconditional logistic regression analysis showed that the risks of birth defects, preterm birth <37 weeks, low birth weight and full-term small for gestational age in survivors were 2.291 times (OR=2.291, 95%CI: 1.643-3.196, P<0.001), 2.572 times (OR=2.572, 95%CI: 1.939-3.413, P<0.001), 3.577 times (OR=3.577, 95%CI: 2.654-4.821, P<0.001) and 4.178 times (OR=4.178, 95%CI: 2.445-7.140, P<0.001) of singletons respectively. The perinatal mortality of survivors was increased non-significantly compared with singletons (OR=1.589, 95%CI: 0.386-6.536, P=0.521).

Conclusions

Perinatal mortality of survivors after VTS in twin pregnancies conceived naturally or by ART is not significantly different from singletons. But the risks of preterm birth, low birth weight, full-term small for gestational age infant, birth defects of survivors after VTS and the risk of hypertension in pregnancy of their pregnant mothers are increased compared with singletons. Early detection for VTS by ultrasound, regular prenatal examinations and fetal malformation screening could improve the perinatal outcomes.

Key words: Pregnancy, twin, Vanishing twin syndrome, Surviving baby, Perinatal outcomes, Risk assessment, Congenital abnormalities, Infant, small for gestational age, Infant, low birth weight, Infant, premature, Infant, newborn
表1 研究组与对照组新生儿临床资料及围生期结局比较[例数(%)]
组别 例数 性别 出生胎龄 出生体重b 足月小于胎龄儿
男 女 <34周 <37周 <2 500 g ≥2 500 g
研究组 381 207(54.3) 174(45.7) 21(5.5) 63(16.5) 57(15.0) 324(85.0) 15(3.9)
对照组 155 179 80 689(52.0) 74 489(48.0) 1 924(1.2) 8 594(5.5) 5 755(3.7) 149 421(96.3) 1 607(1.0)
χ2值   0.829 52.770a 87.464 133.788 31.009
P值   0.363 <0.001 <0.001 <0.001 <0.001
组别 例数 生后1 min Apgar评分c 存活情况 出生7 d内死亡 围生期死亡 出生缺陷e
≤7分 >7分 活产 死胎、死产
研究组 381 6(1.6) 371(98.4) 380(99.7) 1(0.3) 1(0.26) 2(0.5) 41(10.8)
对照组 155 179 1 654(1.1) 151 434(98.9) 154 808(99.8) 371(0.2) 54(0.03) 425(0.3) 6 172(4.0)
χ2值   0.918 —d —d 0.198 45.615
P值   0.311 0.599 0.126 0.656a <0.001
表2 N研究亚组与N对照亚组新生儿临床资料及围生期结局比较[例数(%)]
组别 例数 性别 出生胎龄 出生体重b 足月小于胎龄儿
男 女 <34周 <37周 <2 500 g ≥2 500 g
N研究亚组 187 98(52.4) 89(47.6) 7(3.7) 34(18.2) 26(13.9) 161(86.1) 8(4.3)
N对照亚组 149 900 77 908(52.0) 71 991(48.0) 1 818(1.2) 8 174(5.5) 5 492(3.7) 144 405(96.3) 1 564(1.0)
χ2值   0.014 7.961a 58.534 55.298 18.855
P值   0.906 0.005 <0.001 <0.001 0.001
组别 例数 生后1 min Apgar评分c 存活情况 出生7 d内死亡 围生期死亡 出生缺陷e
≤7分 >7分 活产 死胎、死产
N研究亚组 187 2(1.1) 184(98.9) 186(99.5) 1(0.5) 0(0) 1(0.5) 17(9.1)
N对照亚组 149 900 1 549(1.0) 146 330(99.0) 149 547(99.8) 353(0.2) 52(0.03) 405(0.3) 5 869(3.9)
χ2值   0.001 —d —d —d 13.278
P值   0.722 0.357 1.000 0.398 <0.001
表3 A研究亚组与A对照亚组新生儿临床资料及围生期结局比较[例数(%)]
组别 例数 性别 出生胎龄 出生体重 足月小于胎龄儿
男 女 <34周 <37周 <2 500 g ≥2 500 g
A研究亚组 194 109(56.2) 85(43.8) 14(7.2) 29(14.9) 31(16.0) 163(84.0) 7(3.6)
A对照亚组 5 279 2 781(52.7) 2 498(47.3) 106(2.0) 420(8.0) 263(5.0) 5 016(95.0) 43(0.8)
χ2值   0.922 21.305a 12.149 44.521 16.133
P值   0.337 <0.001 <0.001 <0.001 0.002
组别 例数 生后1 min Apgar评分b 存活情况 出生7 d内死亡 围生期死亡 出生缺陷d
≤7分 >7分 活产 死胎、死产
A研究亚组 194 4(2.1) 187(97.9) 194(100.0) 0(0) 1(0.05) 1(0.5) 24(12.4)
A对照亚组 5 279 105(2.0) 5 104(98.0) 5 261(99.7) 18(0.3) 2(0.04) 20(0.4) 303(5.7)
χ2值   0.006 —c —c —c 14.648
P值   0.794 1.000 0.103 0.532 <0.001
表4 N研究亚组与A研究亚组新生儿临床资料及围生期结局比较[例数(%)]
组别 例数 性别 出生胎龄 出生体重 足月小于胎龄儿
男 女 <34周 <37周 <2 500 g ≥2 500 g  
N研究亚组 187 98(52.4) 89(47.6) 7(3.7) 34(18.2) 26(13.9) 161(86.1) 8(4.3)
A研究亚组 194 109(56.2) 85(43.8) 14(7.2) 29(14.9) 31(16.0) 163(84.0) 7(3.6)
χ2值   0.548 2.205 0.721 0.322 0.007
P值   0.459 0.138 0.396 0.570 0.933
组别 例数 生后1 min Apgar评分a 存活情况 出生7 d内死亡 围生期死亡 出生缺陷d
≤7分 >7分 活产 死胎、死产
N研究亚组 187 2(1.1) 184(98.9) 186(99.5) 1(0.5) 0(0) 1(0.5) 17(9.1)
A研究亚组 194 4(2.1) 187(97.9) 194(100.0) 0(0) 1(0.05) 1(0.5) 24(12.4)
χ2值   0.140b —c —c —c 1.067
P值   0.708 0.490 0.510 0.500 0.302
表5 研究组与对照组孕母相关临床资料比较[例数(%)]
组别 例数 高龄 少数民族 首次妊娠 初产妇 ART受孕 孕前BMI
<24 kg/m2 ≥24~28 kg/m2 ≥28 kg/m2
研究组 381 123(32.3) 24(6.3) 191(50.1) 346(90.8) 194(50.9) 278(73.0) 74(19.4) 29(7.6)
对照组 155 179 29 258(18.9) 10 511(6.8) 66 066(42.6) 133 722(86.2) 5 279(3.4) 118 538(76.4) 27 262(17.6) 9 295(6.0)
χ2值   44.740 0.135 8.877 6.875 2 528.022 2.992
P值   <0.001 0.713 0.003 0.009 <0.001 0.224
组别 例数 不良孕产史 子宫异常 叶酸服用a 产前检查≥5次 分娩医院助产技术服务级别
规律 不规律 未服用 三级 二级
研究组 381 34(8.9) 13(3.4) 275(72.2) 92(24.1) 14(3.7) 378(99.2) 282(74.2) 98(25.8)
对照组 155 179 3 798(2.4) 1 329(0.9) 76 484(49.3) 66 830(43.1) 11 865(7.6) 154 713(99.7) 76 639(49.4) 78 464(50.6)
χ2值   66.348 29.025 79.834 0.109 93.259
P值   <0.001 <0.001 <0.001 0.741 <0.001
组别 例数 妊娠期并发症 剖宫产术分娩
妊娠期高血压疾病 糖尿病 贫血 胎膜早破 胎盘早剥 产后出血
研究组 381 31(8.1) 61(16.0) 49(12.9) 15(3.9) 1(0.3) 15(3.9) 214(56.2)
对照组 155 179 6 108(3.9) 26 776(17.3) 25 440(16.4) 4 125(2.7) 231(0.1) 4 266(2.7) 64 511(41.6)
χ2值   17.690 0.412 3.463 2.399 0.329 2.004 33.327
P值   <0.001 0.521 0.063 0.121 0.566 0.157 <0.001
表6 单胎分娩儿发生围生期死亡影响因素多因素非条件logistic回归分析
影响因素 B SE Wald值 P值 OR值 OR值95%CI
VTS存活儿(vs单胎儿) 0.463 0.722 0.412 0.521 1.589 0.386~6.536
孕母高龄(vs分娩年龄<35岁者) 0.163 0.120 1.847 0.174 1.178 0.930~1.490
ART受孕(vs自然受孕者) 0.307 0.233 1.736 0.188 1.360 0.861~2.147
孕母孕前BMI≥24 kg/m2(vs同期BMI<24 kg/m2者) 0.143 0.079 3.261 0.071 1.154 0.988~1.347
孕母为初产妇(vs经产妇) －0.028 0.141 0.039 0.843 0.973 0.738~1.282
孕母不良孕产史(vs无不良孕产史者) 0.307 0.267 1.316 0.251 1.359 0.805~2.294
孕母子宫异常史(vs无子宫异常史者) 0.213 0.455 0.219 0.640 1.237 0.507~3.018
分娩医院为三级助产技术服务机构(vs二级助产技术服务机构分娩者) 0.015 0.099 0.024 0.878 1.015 0.836~1.234
孕母孕前3个月至早孕期服用叶酸(vs同期未规律服用或未服用者) －0.190 0.077 6.102 0.014 0.827 0.711~0.962
孕母妊娠期高血压疾病(vs无该病者) 0.927 0.168 30.292 <0.001 2.527 1.817~3.516
常数项 －5.985 0.311 369.344 <0.001 0.003 —
表7 单胎分娩儿发生出生缺陷影响因素的多因素非条件logistic回归分析
影响因素 B SE Wald值 P值 OR值 OR值95%CI
VTS存活儿(vs单胎儿) 0.829 0.170 23.852 <0.001 2.291 1.643~3.196
孕母高龄(vs分娩年龄<35岁者) 0.108 0.033 10.864 0.001 1.114 1.045~1.187
ART受孕(vs自然受孕者) 0.280 0.061 21.004 <0.001 1.323 1.174~1.492
孕母孕前BMI≥24 kg/m2(vs同期BMI<24 kg/m2者) 0.095 0.022 18.802 <0.001 1.100 1.054~1.148
孕母为初产妇(vs经产妇) 0.175 0.040 18.688 <0.001 1.191 1.100~1.289
孕母不良孕产史(vs无不良孕产史者) 0.690 0.062 123.718 <0.001 1.994 1.766~2.253
孕母孕前3个月至早孕期服用叶酸(vs同期未规律服用或未服用者) 0.014 0.021 0.457 0.499 1.014 0.973~1.057
孕母妊娠期高血压疾病(vs无该病者) 0.227 0.060 14.337 <0.001 1.255 1.116~1.411
常数项 －3.548 0.056 3 979.790 <0.001 0.029 —
表8 单胎分娩儿发生早产影响因素的多因素非条件logistic回归分析
影响因素 B SE Wald值 P值 OR值 OR值95%CI
VTS存活儿(vs单胎儿) 0.945 0.144 42.884 <0.001 2.572 1.939~3.413
孕母高龄(vs分娩年龄<35岁者) 0.357 0.026 183.280 <0.001 1.429 1.357~1.505
ART受孕(vs自然受孕) 0.238 0.053 20.028 <0.001 1.269 1.143~1.409
孕母孕前BMI≥24 kg/m2(vs同期BMI<24 kg/m2者) 0.208 0.018 135.501 <0.001 1.231 1.189~1.275
孕母为初产妇(vs经产妇) －0.062 0.032 3.841 0.050 0.939 0.883~1.000
孕母不良孕产史(vs无不良孕产史者) 0.216 0.063 11.553 0.001 1.241 1.096~1.405
孕母子宫异常史(vs无子宫异常史者) 0.197 0.104 3.571 0.059 1.217 0.993~1.493
分娩医院为三级助产技术服务机构(vs二级助产技术服务机构分娩者) 0.225 0.023 98.114 <0.001 1.253 1.198~1.310
孕母孕前3个月至早孕期规律服用叶酸(vs同期未规律服用或未服用者) －0.080 0.018 20.306 <0.001 0.923 0.891~0.956
孕母妊娠期高血压疾病(vs无该病者) 1.094 0.038 808.795 <0.001 2.988 2.771~3.222
常数项 －3.697 0.072 2 610.284 <0.001 0.025 —
表9 单胎分娩儿发生低出生体重影响因素的多因素非条件logistic回归分析
影响因素 B SE Wald值 P值 OR值 OR值95%CI
VTS存活儿(vs单胎儿) 1.274 0.152 70.012 <0.001 3.577 2.654~4.821
孕母高龄(vs分娩年龄<35岁者) 0.283 0.032 75.826 <0.001 1.327 1.245~1.414
ART受孕(vs自然受孕) 0.145 0.065 4.946 0.026 1.156 1.017~1.314
孕母孕前BMI≥24 kg/m2(vs同期BMI<24 kg/m2者) 0.025 0.023 1.164 0.281 1.025 0.980~1.072
孕母为初产妇(vs经产妇) 0.182 0.042 18.864 <0.001 1.200 1.105~1.303
孕母不良孕产史(vs无不良孕产史者) 0.190 0.078 5.965 0.015 1.209 1.038~1.409
孕母子宫异常史(vs无不良异常史者) 0.074 0.133 0.310 0.578 1.077 0.830~1.397
分娩医院为三级助产技术服务机构(vs二级助产技术服务机构分娩者) 0.227 0.028 67.856 <0.001 1.254 1.189~1.324
孕母孕前3个月至早孕期规律服用叶酸(vs同期未规律服用或未服用者) －0.059 0.022 7.339 0.007 0.943 0.904~0.984
孕母妊娠期高血压疾病(vs无该病者) 1.490 0.042 1 274.281 <0.001 4.437 4.089~4.815
常数项 －4.133 0.089 2 141.375 <0.001 0.016 —
表10 单胎分娩儿发生足月小于胎龄儿影响因素的多因素非条件logistic回归分析
影响因素 B SE Wald值 P值 OR值 OR值95%CI
VTS存活儿(vs单胎儿) 1.430 0.273 27.356 <0.001 4.178 2.445~7.140
孕母高龄(vs分娩年龄<35岁者) 0.183 0.063 8.475 0.004 1.201 1.062~1.358
ART受孕(vs自然受孕) －0.342 0.150 5.160 0.023 0.711 0.529~0.954
孕母孕前BMI≥24 kg/m2(vs同期BMI<24 kg/m2者) －0.199 0.047 17.726 <0.001 0.819 0.747~0.899
孕母为初产妇(vs经产妇) 0.504 0.088 32.637 <0.001 1.655 1.392~1.968
孕母不良孕产史(vs无不良孕产史者) －0.185 0.178 1.080 0.299 0.831 0.586~1.178
孕母子宫异常史(vs无子宫异常史者) －0.366 0.320 1.311 0.252 0.693 0.370~1.298
分娩医院为三级助产技术服务机构(vs二级助产技术服务机构分娩者) 0.050 0.051 0.963 0.326 1.051 0.952~1.160
孕母孕前3个月至早孕期规律服用叶酸(vs同期未规律服用或未服用者) －0.025 0.040 0.383 0.536 0.975 0.901~1.055
孕母妊娠期高血压疾病(vs无该病者) 1.153 0.085 183.657 <0.001 3.168 2.681~3.743
常数项 －4.936 0.170 846.874 <0.001 0.007 —
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