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

Abstract

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

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.

Figures/Tables 6

References 24

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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

Study on the correlation between the changes in hemoglobin level during pregnancy and perinatal outcomes of twins

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