孕期血红蛋白水平变化与双胎围产儿结局相关性研究

doi:10.12372/jcp.2024.23e0956

摘要/Abstract

摘要：

目的研究孕期母体血红蛋白水平及其变化与双胎围产儿结局的相关性。方法回顾性分析2015年5月至2022年11月行产前检查及分娩的双胎妊娠产妇的临床资料。结果纳入分析2 524例双胎妊娠产妇，早孕期平均血红蛋白（Hb）为（118.0±10.9）g/L，高于晚孕期的（116.6±13.0）g/L，差异有统计学意义（P<0.01）。早孕期缺铁性贫血的发生率为22.1%，晚孕期为27.7%。高Hb（Hb>130g/L）可能与新生儿窒息（AOR=2.10，95%CI：1.13~3.87）和小于胎龄儿（AOR=1.39，95%CI：1.09~1.98）的发生风险增加相关。早孕期中重度贫血可能增加了小于胎龄儿（AOR=2.61，95%CI：1.52~4.49）的发生风险。早孕期轻度贫血并未增加围产儿不良结局的发生风险。早孕期轻度贫血在晚孕期如得到纠正，新生儿窒息（AOR=0.27，95%CI：0.07~0.97）风险较持续贫血者可能降低，且双胎之大胎儿出生体重较高（P<0.05）。结论与双胎妊娠持续贫血者相比，晚孕期贫血纠正者可能减少了新生儿窒息的风险。因此，需强调对双胎妊娠贫血孕妇孕期补铁及Hb监测的必要性。

关键词: 双胎妊娠, 缺铁性贫血, 高血红蛋白, 新生儿

Abstract:

Objective To study the correlation between maternal hemoglobin level during pregnancy and perinatal outcome of twins. Methods The clinical data of pregnant women with twin pregnancies who underwent prenatal examination and delivery from May 2015 to November 2022 were retrospectively analyzed. Results A total of 2524 women with twin pregnancies were included. The mean hemoglobin (Hb) in early pregnancy was (118.0±10.9) g/L, higher than that in late pregnancy, (116.6±13.0) g/L, and the difference was statistically significant (P<0.01). The incidence of iron deficiency anemia was 22.1% in early pregnancy and 27.7% in late pregnancy. High Hb (Hb>130g/L) might be associated with an increased risk of neonatal asphyxia (AOR=2.10, 95%CI: 1.13-3.87) and small for gestational age infants (AOR=1.39, 95%CI: 1.09-1.98). Moderate to severe anemia during early pregnancy might increase the risk of small for gestational age infants (AOR=2.61, 95%CI: 1.52-4.49). Mild anemia in early pregnancy did not increase the risk of perinatal adverse outcomes. If mild anemia in early pregnancy was corrected in late pregnancy, the risk of neonatal asphyxia (AOR=0.27, 95%CI: 0.07-0.97) might be reduced compared with those with persistent anemia, and the birth weight of larger fetuses in twins is higher (P<0.05). Conclusions Compared with those with persistent anemia in twin pregnancies, the risk of neonatal asphyxia was reduced in those whose anemia was corrected in late pregnancy. Therefore, the necessity of iron supplementation and Hb monitoring for anemic pregnant women with twin pregnancies should be emphasized.

Key words: twin pregnancy, iron deficiency anemia, high hemoglobin, neonatal

马珏, 薛瑞洪, 谢金亮, 王彦林. 孕期血红蛋白水平变化与双胎围产儿结局相关性研究[J]. 临床儿科杂志, 2024, 42(1): 28-34.

MA Jue, XUE Ruihong, XIE Jinliang, WANG Yanlin. Study on the correlation between the changes in hemoglobin level during pregnancy and perinatal outcomes of twins[J]. Journal of Clinical Pediatrics, 2024, 42(1): 28-34.

图/表 6

图1

表1

表2

表3

表4

表5

参考文献 24

[1]	Churchill D, Nair M, Stanworth SJ, et al. The change in haemoglobin concentration between the first and third trimesters of pregnancy: a population study[J]. BMC Pregnancy childbirth, 2019, 19(1): 359-364. doi: 10.1186/s12884-019-2495-0
[2]	Ru Y, Pressman EK, Cooper EM, et al. Iron deficiency and anemia are prevalent in women with multiple gestations[J]. Am J Clin Nutr, 2016, 104(4): 1052-1060. pmid: 27581469
[3]	Shinar S, Shapira U, Maslovitz S. Redefining normal hemoglobin and anemia in singleton and twin pregnancies[J]. Int J Gynaecol Obstet, 2018, 142(1): 42-47. doi: 10.1002/ijgo.12506 pmid: 29637566
[4]	Abbas AM, Elhalwagy MM, Afifi K, et al. Single vs. double dose iron supplementation for prevention of iron deficiency anemia in twin pregnancy: a randomized controlled clinical trial[J]. Open J Obstet Gynecol, 2020, 10(12): 1788-1802. doi: 10.4236/ojog.2020.10120161
[5]	Blitz MJ, Yukhayev A, Pachtman SL, et al. Twin pregnancy and risk of postpartum hemorrhage[J]. J Matern Fetal Neonatal Med, 2020, 33(22): 3740-3745. doi: 10.1080/14767058.2019.1583736 pmid: 30836810
[6]	马珏, 潘漪莲, 王彦林. 双胎早孕期轻度贫血对妊娠结局的影响[J]. 中国计划生育和妇产科, 2019, 11(4): 37-40.
[7]	谢幸, 孔北华, 段涛. 妇产科学[M]. 9版. 北京: 人民卫生出版社, 2018.
[8]	World Health Organization. Vitamin and mineral nutrition information system: haemoglobin concentrations for the diagnosis of anaemia and assessment of severity[EB/OL]. Geneva: World Health Organization, 2011 [2020-03-12]. http//www.who.int/vmnis/indicators/haemoglobin.pdf.
[9]	Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, et al. Daily oral iron supplementation during pregnancy[J]. Cochrane Database Syst Rev, 2015, 2015(7): CD004736.
[10]	Dai L, Deng C, Li Y, et al. Population-based birth weight reference percentiles for Chinese twins[J]. Ann Med, 2017, 49(6): 470-478. doi: 10.1080/07853890.2017.1294258 pmid: 28276868
[11]	谢芳, 刘彩霞, 刘婧一, 等. 中国部分地区双胎妊娠孕期贫血6063例临床分析[J]. 中国实用妇科与产科杂志, 2023, 39(2): 209-212.
[12]	Young MF, Oaks BM, Tandon S, et al. Maternal hemo-globin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis[J]. Ann N Y Acad Sci, 2019, 1450(1): 47-68. doi: 10.1111/nyas.v1450.1
[13]	孙梦星, 石慧峰, 魏瑷. 双胎妊娠缺铁性贫血的监测和管理研究进展[J]. 中国实用妇科与产科杂志, 2021, 37(9): 978-981.
[14]	Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies: ACOG practice bulletin summary, number 231[J]. Obstet Gynecol, 2021, 137(6): 1140-1143. doi: 10.1097/AOG.0000000000004398 pmid: 34011883
[15]	World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience[EB/OL]. Geneva: World Health Organization, 2016 [2020-03-2]. https://apps.who.int/iris/bitstream/handle/10665/250796/9789241549912-eng.pdf.
[16]	Pavord S, Daru J, Prasannan N, et al. UK guidelines on the management of iron deficiency in pregnancy[J]. Br J Haematol, 2020, 188(6): 819-830. doi: 10.1111/bjh.v188.6
[17]	中国妇幼保健协会双胎妊娠专业委员会. 双胎妊娠期缺铁性贫血诊治及保健指南(2023年版)[J]. 中国实用妇科与产科杂志, 2023, 39(4): 419-430.
[18]	Sun CC, Chou HH, Chuang LL. Trends and risk factors of stillbirth in Taiwan 2006—2013: a population-based study[J]. Arch Gynecol Obstet, 2019, 299(4): 961-967. doi: 10.1007/s00404-019-05090-3
[19]	Zhang Q, Ananth CV, Li Z, et al. Maternal anaemia and preterm birth: a prospective cohort study[J]. Int J Epidemiol, 2009, 38(5): 1380-1389. doi: 10.1093/ije/dyp243 pmid: 19578127
[20]	Figueiredo ACMG, Gomes-Filho IS, Silva RB, et al. Maternal anemia and low birth weight: a systematic review and meta-analysis[J]. Nutrients, 2018, 10(5): 601. doi: 10.3390/nu10050601
[21]	Hämäläinen H, Hakkarainen K, Heinonen S. Anaemia in the first but not in the second or third trimester is a risk factor for low birth weight[J]. Clin Nutr, 2003, 22(3): 271-275. doi: 10.1016/s0261-5614(02)00209-1 pmid: 12765667
[22]	Shi H, Chen L, Wang Y, et al. Severity of anemia during pregnancy and adverse maternal and fetal outcomes[J]. JAMA Netw Open, 2022, 5(2): e2147046. doi: 10.1001/jamanetworkopen.2021.47046
[23]	Sun CF, Liu H, Hao YH, et al. Association between gestational anemia in different trimesters and neonatal outcomes: a retrospective longitudinal cohort study[J]. World J Pediatr, 2021, 17(2): 197-204. doi: 10.1007/s12519-021-00411-6
[24]	赵晓南, 刘玉芳, 王秀献. 孕晚期妇女铁蛋白水平及母婴结局临床分析[J]. 现代妇产科进展, 2022, 31(1): 58-60.

项目	例数	早孕期Hb水平/g·L^-1	晚孕期Hb水平/g·L^-1
母亲年龄
≤24岁	76	116.77±10.17	111.63±13.23
25~29岁	753	117.35±11.4	116.26±13.05¹⁾
30~34岁	1 213	118.19±10.75	116.98±13.10¹⁾
≥35岁	482	118.92±10.45	117.05±12.70¹⁾
F值		2.49	4.39
P		0.058	0.004
产次
0次	2 357	118.05±10.92	116.83±12.91
≥1次	167	117.77±10.35	113.54±14.39
t值		0.32	2.88
P		0.747	0.004
孕前体质指数
<18 kg·m^-2	170	114.98±10.19²⁾	117.38±10.42
18~24 kg·m^-2	1 931	117.83±10.32	116.27±11.98
>24 kg·m^-2	423	120.22±9.93²⁾	117.91±12.09
F值		11.12	0.58
P		<0.001	0.560
受孕方式
自然受孕	1 327	117.53±10.78	115.58±13.14
辅助生殖	1 197	118.60±10.98	117.76±12.84
t值		2.45	4.21
P		0.014	<0.001

组别	例数		围产儿结局
组别	例数		早产	小于胎龄儿	新生儿窒息	围产儿死亡
早孕期
正常Hb组	1 634	n(%)	1 091(66.8)	122(7.5)	37(2.3)	7(0.4)
正常Hb组	1 634	OR	1	1	1	1
高Hb组	333	n(%)	211(63.4)	22(6.6)	15(4.5)	3(0.9)
高Hb组	333	AOR(95% CI)	0.86(0.67~1.10)	0.87(0.54~1.39)	2.10(1.13~3.87)	2.16(0.55~8.41)
轻度贫血组	453	n(%)	275(60.7)	32(7.1)	11(2.4)	2(0.4)
轻度贫血组	453	AOR(95% CI)	0.77(0.62~1.00)	0.95(0.63~1.42)	1.08(0.55~2.14)	1.02(0.21~4.97)
中重度贫血组	104	n(%)	70(67.3)	18(17.3)	2(1.9)	0(0.0)
中重度贫血组	104	AOR(95% CI)	1.02(0.67~1.56)	2.61(1.52~4.49)	0.86(0.20~3.63)	－
晚孕期
正常Hb组	1 427	n(%)	904(63.3)	105(7.4)	30(2.1)	5(0.4)
正常Hb组	1 427	OR	1	1	1	1
高Hb组	398	n(%)	265(66.6)	38(9.5)	13(3.3)	2(0.5)
高Hb组	398	AOR(95% CI)	1.17(0.92~1.48)	1.39(1.09~1.98)	1.63(0.84~3.16)	1.36(0.26~7.05)
轻度贫血组	420	n(%)	281(66.9)	31(7.4)	17(4.0)	5(1.2)
轻度贫血组	420	AOR(95% CI)	1.14(0.90~1.43)	0.98(0.64~1.49)	1.89(1.03~3.48)	3.43(0.99~11.96)
中重度贫血组	279	n(%)	197(70.6)	20(7.2)	5(1.8)	0(0.0)
中重度贫血组	279	AOR(95% CI)	1.34(1.02~1.79)	0.92(0.56~1.52)	0.76(0.29~2.01)	－

组别	早孕期				晚孕期
组别	例数	分娩孕周/周	双胎之较小胎儿出生体重/kg	双胎之较大胎儿出生体重/kg	例数	分娩孕周/周	双胎之较小胎儿出生体重/kg	双胎之较大胎儿出生体重/kg
正常Hb组	1 634	35.89±1.65	2.33±0.41	2.61±0.41	1 427	35.98±1.63	2.34±0.41	2.65±0.41
高Hb组	333	35.74±1.96	2.32±0.45	2.60±0.44	398	35.91±1.64	2.31±0.41	2.60±0.40
轻度贫血组	453	36.02±1.70	2.34±0.43	2.62±0.41	420	35.77±1.89	2.34±0.45	2.59±0.44
中重度贫血组	104	36.03±1.76	2.24±0.38	2.54±0.36	279	35.64±1.85¹⁾	2.27±0.39¹⁾	2.56±0.38¹⁾
F值		1.97	1.64	1.07		3.97	3.96	4.16
P		0.117	0.178	0.360		0.008	0.036	0.006

组别	例数		围产儿结局
组别	例数		早产	小于胎龄儿	新生儿窒息	围产儿死亡
持续贫血组	174	n(%)	106(60.9)	11(6.3)	8(4.6)	2(1.1)
		OR	1	1	1	1
贫血恢复组	279	n(%)	169(60.6)	21(7.5)	3(1.1)	0(0.0)
		AOR(95%CI)	1.10(0.74~1.65)	1.17(0.54~2.52)	0.27(0.07~0.97)	－

项目	持续性贫血组(n=174)	贫血恢复组(n=279)	t值	P
早孕期Hb/g·L^-1	105.17±2.56	105.53±2.66	1.42	0.157
晚孕期Hb/g·L^-1	99.59±7.24	118.98±6.57	23.39	<0.001
分娩孕周/周	35.84±1.89	36.13±1.57	1.72	0.087
双胎之较小胎儿出生体重/kg	2.30±0.47	2.36±0.39	1.52	0.128
双胎之较大胎儿出生体重/kg	2.56±0.43	2.60±0.39	2.22	0.027