Perinatal Analysis Of Twin Pregnancies With Combined Iron Deficiency Anaemia

Objective:To investigate the effect of iron deficiency anaemia on maternal and fetal outcomes in twin pregnancies and to provide a clinical basis for maternal and fetal monitoring during pregnancy and for clinicians to guide pregnancies in this population in order to reduce the incidence of adverse pregnancy outcomes.Methods.:We retrospectively analyzed the clinical data of 128 women with twin pregnancies combined with iron deficiency anemia(experimental group),216 women with twin pregnancies without iron deficiency anemia(control group 1),and 314 women with singleton pregnancies combined with iron deficiency anemia(control group 2)and twin newborns admitted to the First Hospital of Jilin University from January 2020 to June 2022,and collected general maternal data: age,number of pregnancies and deliveries The data were collected on general maternal data: age,number of pregnancies,gestational weeks,cesarean delivery rate;pregnancy complications: preterm birth,hypertensive disorders in pregnancy,uterine contractions,premature rupture of membranes,gestational diabetes mellitus,hypothyroidism in pregnancy;pregnancy outcomes: postpartum haemorrhage,gestational weeks of labour,caesarean section or not.;maternal iron supplementation and the effect of different doses on complications.Newborn birth weight of twins,neonatal outcome of twins: clinical data of neonatal blood gas hemoglobin and Apgar score,comparing the differences of related indicators.The twin fetuses were partly based on early ultrasound and case documentation of chorionicity in twin pregnancies,and a total of 287 patients with chorionicity were obtained,5 with single chorion and single sheep,66 with single chorion and double sheep and 216 with double chorion and double sheep.There were 43 cases of stillbirths after twin deliveries,and a total of 658 cases of live births with fetal weight.Blood gas analysis and Apgar results,excluding incomplete results,yielded 444 fetal blood gas hemoglobin results as well as 629 fetal Apgar score results.The fetal part compared the difference of maternal anemia on chorionicity,fetal weight of twin fetuses,neonatal blood gas hemoglobin of twin fetuses,and Apgar score of twin fetuses in the twin group.Results:1.Between the three groups of maternal gestation and delivery,there was no statistically significant difference(P > 0.05).There was a statistically significant difference in assisted reproduction(P < 0.0167)and no statistically significant difference(P > 0.0167)in age,gestation,and delivery between the twin anemic groups compared to the singleton anemic group.There was a statistically significant difference in assisted reproduction and age between the twin non-anemic group compared with the singleton anemic group(P < 0.0167),and no statistically significant difference in the number of pregnancies and deliveries(P > 0.0167).There were no statistically significant differences in age,gestation,delivery,and assisted reproduction between the twin-anemic group and the twin-nonanemic group(P >0.0167).2.Among the maternal complications between the three groups: preterm birth,hypertensive disorders of pregnancy,lack of uterine contractions,premature rupture of membranes and gestational diabetes mellitus,the differences were statistically significant(P < 0.05).There was a statistically significant difference in the occurrence of preterm labour,hypertensive disorders of pregnancy and uterine contraction weakness in the twin foetus anaemia group compared to the single foetus anaemia group(P < 0.0167).There was a statistically significant difference in the incidence of preterm labour,hypertensive disorders of pregnancy,uterine contraction weakness,premature rupture of membranes and gestational diabetes mellitus in the twin non-anaemic group compared to the singleton anaemic group(P < 0.0167).There was a statistically significant difference between the twin anaemic group and the twin non-anaemic group,and the difference in hypertensive disorders of pregnancy(P <0.0167).3.There was a statistically significant difference in the rate of caesarean section,gestational week of labour and bleeding at delivery in the twin anaemic group compared with the singleton anaemic group(P < 0.0167).In the twin non-anaemic group compared with the singleton anaemic group,there was a statistically significant difference in the rate of caesarean section,gestational week of labour and haemorrhage at delivery(P < 0.0167).In the twin-anemic group,there was no statistically significant difference in the rate of cesarean delivery,week of labour and amount of bleeding at delivery compared with the twin-nonanemic group(P>0.0167).4.The rate of iron and other non-iron supplementation was statistically significantly higher in the twin-anemic group compared to the singleton-anemic group(P < 0.0167).The rate of taking other non-iron blood supplements was higher in the twin pregnancy anaemia group compared with the singleton anaemia group,which was about twice as high as that in the singleton anaemia group,and the difference was statistically significant(P < 0.0167),while the difference in the rate of taking iron in the two groups was not statistically significant(P > 0.0167).5.5 cases of twin pregnancies in the MCMA group,1 case in the anaemic group and 4 cases in the non-anaemic group.66 cases in the MCDA group,28 cases in the anaemic group and 38 cases in the non-anaemic group.216 cases in the DCDA group,84 cases in the anaemic group and 132 cases in the non-anaemic group.There was no statistical difference between the three groups in terms of whether they were anaemic or not(P>0.05).6.Of the 658 live births,there were 416 fetuses with a mean weight of 2.43(2.02-2.76)kg in the non-anaemic group and 242 fetuses with a mean weight of 2.37(1.92-2.74)kg in the anaemic group.The ages of both groups did not conform to a normal distribution.There was no statistical difference in neonatal weight between the two groups(P > 0.05).However,we found a mean fetal weight of 2.26(1.87-2.65)kg in the MCDA group and 2.44(2.03-2.79)kg in the DCDA group,which was statistically different between the two groups(P < 0.05).7.A total of 444 fetal blood gas haemoglobin results were obtained.The results showed that there were 42 cases(23.1%)of fetal anaemia in the maternal anaemia group and 37 cases(14.0%)of fetal anaemia in the maternal non-anaemic group.There was a statistical difference between maternal anaemia and fetal anaemia(P <0.05).8.There were 24 cases(10.5%)with Apgar score below 7 in the anaemic group and 31 cases(7.8%)with Apgar score below 7 in the non-anaemic group,with no statistical difference between the two groups(P > 0.05).There was no difference in heart rate,muscle tone,skin colour and reflex activity between the anaemic and non-anaemic groups for each of these items.However,there were 152 cases(66.7%)in the paediatric respiratory item anaemia group and 230 cases(57.5%)in the non-anaemic group,with statistical differences between the two groups(P < 0.05).Conclusion:1.The twin birth factor significantly influenced the occurrence of preterm birth,hypertensive disorders of pregnancy,premature rupture of membranes,lack of uterine contractions and gestational diabetes mellitus.2.Iron deficiency anaemia is not a major factor affecting the gestational week of delivery,mode of delivery and postpartum haemorrhage in twin pregnancies,but it affects the occurrence of hypertensive disorders of pregnancy.3.Maternal anaemia can affect the haemoglobin level of the newborn after birth and can affect the respiratory level of the newborn after birth,and should be dealt with in the first instance to avoid adverse pregnancy outcomes.4.Chorionicity in twin pregnancies does not correlate with maternal anaemia,but can affect neonatal weight,which is relatively lower in the MCDA group than in the DCDA group.5.Iron supplementation at a dose of 100-200mg/day in twin pregnancies significantly reduced the incidence of preterm labor,HDP,and uterine contraction weakness,while iron supplementation at a dose greater than 200mg/day did not reduce the incidence of pregnancy complications and increased the risk of GDM.