Systematic Management of Twin Pregnancies to Reduce Pregnancy Complications
Twin pregnancies have seen a significant increase in recent decades, primarily due to the growing use of assisted reproductive techniques. However, these pregnancies are associated with high infant morbidity and mortality, as well as a range of maternal complications. Maternal obesity, in particular, has been identified as a significant risk factor for adverse outcomes such as pre-eclampsia, gestational diabetes mellitus (GDM), preterm birth, and fetal growth restriction. This study aims to assess the benefits of systematic management of twin pregnancies, with a focus on GDM-like diet and exercise management models, to reduce these complications.
The study examined data from all twin pregnancies at the International Peace Maternity and Child Health Hospital in Shanghai, China, from January 1, 2013, to December 31, 2017. The research was approved by the hospital’s Ethics Committee, and all participants provided written informed consent. A specialist clinic for twin pregnancies was established in mid-2014, where systematic guidance on diet, physical activity, weight control, sleep, and mental health was provided. The weight control recommendations followed the 2009 guidelines from the Institute of Medicine.
The study population included twin pregnancies delivered between 2015 and 2017, with those delivered between 2013 and 2014 serving as the control group. Inclusion criteria were twin deliveries after 26 weeks of pregnancy, while exclusion criteria included gestational age at delivery of less than 26 weeks, stillbirth before labor, and fetal reduction for congenital fetal anomalies. The research compared pregnancy complications between the two groups to assess the benefits of systematic management.
Data were analyzed for missing and extreme values, and descriptive statistics were used to present the numbers and percentages for categorical variables. Prenatal weight gain data were presented as mean ± standard deviation. Differences in ages and pre-pregnancy body mass index (BMI) between the two groups were assessed using independent-sample t-tests, and chi-square tests were used for dichotomous outcomes. Logistic regression was used to determine the risk ratio (RR) and 95% confidence intervals (CIs) of pregnancy complications. All data were analyzed using SPSS software, with a P value of less than 0.05 considered statistically significant.
After applying the inclusion and exclusion criteria, the study included data from 1994 twin pregnancies. The control group consisted of 710 twin pregnancies, while the intervention group included 1284 twin pregnancies. The study found that systematic management significantly reduced the rates of several maternal complications. For instance, the rate of preterm birth among obese and overweight women in the intervention group was 45.8%, compared to 73.6% in the control group (P < 0.01, RR: 2.965, 95% CI: 1.84–4.79). Additionally, the intervention group showed significant declines in the rates of hyperthyroidism (3.8% vs. 2.3%, P < 0.05, RR: 1.711, 95% CI: 1.01–2.91), anemia (22.5% vs. 17.8%, P < 0.05, RR: 1.347, 95% CI: 1.07–1.69), and postpartum hemorrhage (6.9% vs. 4.6%, P < 0.05, RR: 1.539, 95% CI: 1.04–2.27).
The study also observed declines in the rates of gestational hypertension, GDM, and other related complications in the intervention group, although these differences were not statistically significant. The theoretical basis for the management plan included the recognition of pregnancy as a diabetogenic event influenced by placental hormones, the increased risk of morbid obesity in twin pregnancies, and the importance of physical activity in maintaining maternal health.
The comorbidity of obesity and GDM was identified as a critical factor in the prognosis of twin pregnancies. Regular physical activity was shown to reduce the risk of GDM and improve glucose metabolism. The study found no significant relationship between GDM and preterm birth, consistent with previous meta-analyses. Maternal anemia was also identified as a risk factor for preterm birth, with the intervention group showing a significant reduction in anemia rates.
Comprehensive management, including dietary guidance and physical activity, helped control maternal weight and reduce the incidence of GDM and gestational hypertension in obese twin pregnancies. The study highlighted the importance of systematic management, particularly GDM-like diet and exercise models, in reducing perinatal complications in twin pregnancies. Regular physical activity did not increase the rate of preterm birth and was associated with a reduced risk of postpartum hemorrhage.
In conclusion, systematic management of twin pregnancies, with a focus on diet, physical activity, and weight control, can significantly reduce the risk of maternal and fetal complications. Future studies are needed to further analyze the impact of systematic management on complex twin pregnancies and to refine the guidelines for managing these high-risk pregnancies.
doi.org/10.1097/CM9.0000000000000808
Was this helpful?
0 / 0