孕中期糖化血红蛋白不同控制水平的双胎妊娠期糖尿病患者不良妊娠结局比较OA

Objective To compare differences in adverse pregnancy outcomes among women with twin gestational di-abetes mellitus(GDM)at different second-trimester glycated hemoglobin(HbA1c)control levels,and to investigate the applicability of the HbA1c threshold of 5.5%—commonly used in singleton GDM populations—for risk stratification of ad-verse pregnancy outcomes in women with twin GDM.Methods The retrospective cohort of 361 women with twin GDM was recruited.Using the HbA1c threshold of 5.5%commonly applied in singleton GDM,the cohort was divided into the group A(HbA1c≥5.5%,n=62)and group B(HbA1c<5.5%,n=299)based on mid-pregnancy HbA1c levels.Clinical characteristics(age,pre-pregnancy BMI,gestational age at delivery,mode of conception,chorionicity,parity,HbA1c levels,and fasting,1-hour and 2-hour glucose levels in the oral glucose tolerance test),maternal outcomes(pre-eclamp-sia,preterm birth,postpartum haemorrhage,intrahepatic cholestasis of pregnancy,gestational hypothyroidism,anaemia in pregnancy,polyhydramnios and preterm rupture of membranes),and neonatal outcomes[small for gestational age(SGA),large for gestational age(LGA),neonatal hypoglycaemia,neonatal respiratory distress syndrome,neonatal as-phyxia,neonatal wet lung and neonatal hyperbilirubinaemia],and the distribution of birth weight discordance in twin preg-nancies were compared between the two groups;binary Logistic regression analysis was performed on outcomes showing sta-tistically significant differences.Results Pre-pregnancy BMI and fasting plasma glucose level of OGTT in the group A were significantly higher than those in the group B(both P<0.05).The incidence of preeclampsia in the group B was low-er than that in the group A(P<0.05).There were no significant differences in the incidences of preterm birth,postpartum hemorrhage,intrahepatic cholestasis of pregnancy,hypothyroidism,pregnancy complicated with anemia,polyhydramni-os,or premature rupture of membranes between the two groups(all P>0.05).After adjustment for age,pre-pregnancy BMI,gravidity and parity,and chorionicity by binary Logistic regression analysis,the difference in preeclampsia inci-dence was not statistically significant(OR=1.531,95%CI:0.681-3.446,P=0.303).There were no significant differ-ences in the incidences of SGA,LGA,neonatal hypoglycemia,neonatal respiratory distress syndrome,neonatal asphyxia,neonatal wet lung,or neonatal hyperbilirubinemia between the two groups(all P>0.05).The overall distribution of birth weight discordance rate in twins was not significantly different between the two groups(P>0.05).The constituent ratio in the 0%-<10%interval was higher in the group A,while those in the 10%-<15%and 15%-<20%intervals were higher in the group B;the distribution in the≥20%interval was similar between the two groups.Conclusions Most adverse preg-nancy outcomes show no significant differences between twin pregnancies with GDM at different second-trimester HbA1c control levels.The applicability of the HbA1c threshold of 5.5%commonly used in singleton pregnancies for risk stratifica-tion in twin GDM pregnancies still needs further verification.