| ObjectiveTo explore the relationship between gestational diabetes mellitus and birth weight discordance twins(BWDT)under different conception methods.MethodsA retrospective analysis was performed on the clinical data of 3974 pairs of twin fetuses born in the Third Affiliated Hospital of Guangzhou Medical University from January 1,2011 to December 31,2020 with complete birth data,divided into two groups by different conception methods,namely spontaneous conception group(1431 cases)and assisted reproduction group(2543 cases),and analyzed the impact of different conception methods on the occurrence of birth weight discordance twins(BWDT),According to the results,they were divided into four groups based on different conception methods and whether the pregnant mother had gestational diabetes mellitus(GDM): spontaneous conception GDM group(250 cases),spontaneous conception non-GDM group(1117 cases),assisted reproduction GDM group(572 cases),and assisted reproduction non-GDM group(1886 cases),and the effects of different pregnancy methods and gestational diabetes mellitus on the birth weight discordance twins were further analyzed.SPSS 26.0 statistical software was used for data analysis,When P<0.05,the difference was statistically significant.Results1.Basic information of mothers and complications during pregnancy in assisted reproduction group and spontaneous conception group: the proportion of elderly maternal(≥ 35 years old),first pregnancy and first birth in the assisted reproduction group was higher than that in the spontaneous conception group,and the differences were statistically significant(P<0.05).The classification of maternal BMI before pregnancy was divided into four subgroups according to the different levels of preconception BMI,among which BMI < 18.5 group and BMI≥28 group accounted for a higher proportion of spontaneous conception,and the assisted reproduction group of mothers with BMI 24.0-27.9 group was higher.The chorionic nature of the twin properties of the assisted reproduction group were mainly dichorionic diamniotic,which accounted for a higher proportion than that of the spontaneous conception group,while the proportion of the monoamniotic twin was higher in the spontaneous conception group,and the differences were statistically significant(P<0.05).In the assisted reproduction group,the percentage of mothers with gestational diabetes mellitus was relatively high,and they were more likely to have hypothyroidism.2.Birth outcomes and birth weight of newborns in assisted reproduction group and spontaneous conception group: the birth weight of newborns in the assisted reproduction group was higher than that in the spontaneous conception group(P<0.001),and the incidence of low birth weight in the spontaneous conception group was higher(P<0.001),the difference in birth weight between twins in the assisted reproduction group(11.86±10.76)was smaller than the spontaneous conception group(13.45±13.32)(P<0.001),and the incidence of BWDT in the assisted reproduction group was lower(P<0.001).The incidence of preterm birth(gestational age<37 weeks)in the assisted reproduction group was lower in the assisted reproduction group than in the spontaneous conception group(P<0.05),After controlling for a slew of confounding factors,the unconditioned Logistic regression analysis,showed that gestational age was an independent risk factor for BWDT.3.The incidence of gestational diabetes mellitus in different conception methods:the incidence of GDM was 18.29% in spontaneous conception group and 23.27% in the assisted reproduction group.The differences of preterm birth,Apgar score at birth,gender of twins,and admission to neonatology department after birth between the four groups(spontaneous conception GDM group,spontaneous conception non-GDM group,assisted reproduction GDM group,assisted reproduction non-GDM group)were statistically significant,and the proportion of preterm birth in the spontaneous conception GDM group was the highest.4.Twin birth outcomes and birth weight of different conception methods,as well as the presence of gestational diabetes mellitus: the average birth weight of the four groups was(2289.12±549.58)g,(2263.00±576.26)g,(2416.01±543.73)g,(2352.95±555.00)g,with statistically significant differences(P<0.001).The highest in the assisted reproduction GDM group and the lowest in the spontaneous conception non-GDM group.LGA was more common in the heavier children of the assisted reproductive technology GDM group than in the spontaneous conception non-GDM group(15.7%),and the difference was statistically significant(P < 0.001).The incidence of LGA in the lighter infants in the assisted reproductive technology GDM group was 6.8%,which was higher than that in the spontaneous conception non-GDM group(2.6%),and the difference was statistically significant(P=0.001).There were significant differences in the birth weight of SGA and twins between the heavier and lighter infants(P=0.002;P < 0.001;P=0.001),and between the 5 subgroups of BWDT,the group of BWDT> 25% was statistically significant(P=0.009),and the proportion of BWDT in the assisted reproductive technology GDM group was the least(8.0%).5.Univariate and multivariate Logistic regression analysis showed that the incidence of GDM in assisted reproductive technology group was 1.36 times higher than that in spontaneous conception group(OR=1.36,95%CI: 1.15-1.60).Assisted reproductive technology was an independent risk factor for GDM in twin pregnancy.6.Regression analysis of conception mode and GDM on BWDT: the risk of assisted reproductive technology GDM was 0.69 times higher than that in spontaneous conception non-GDM(OR=0.69,95%CI: 0.49-0.99),and assisted reproductive technology GDM was an independent protective factor for discordant birth weight.7.Multivariate Logistic regression analysis of the relationship between assisted reproductive technology GDM and LGA: the risk of LGA in assisted reproductive technology GDM was 2.55 times higher than that in spontaneous conception non-GDM(OR=2.55,95%CI: 1.98-3.30,P<0.001).Assisted reproductive technology GDM was an independent risk factor for LGA in heavier infants.Conclusion1.The mothers of assisted reproduction are mostly old age,first pregnancy and first birth,so attention should be paid to strengthening blood glucose monitoring and scientific management,and thyroid function to prevent GDM and hypothyroidism.2.GDM of assisted reproduction is an independent protective factor of BWDT,and LGA accounts for a large proportion in this population,suggesting that in future medical activities,quality growth of twin fetuses should be strictly monitored when GDM is complicated in pregnancy of assisted reproductive technology pregnant women,and health education and regular follow-up should be conducted after birth. |
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