Association of Birthweight Discordance with Adverse Birth Outcomes Among Live-Born Twins: A Multi-Center Study in China.

IF 3.2 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology Pub Date : 2025-07-08 eCollection Date: 2025-01-01 DOI:10.2147/CLEP.S526154

Bijun Shi, Xiaohua Tan, Qian Chen, Danfang Lu, Shuhua Ren, Kang Huang, Wei Shen, Zhifeng Chen, Jin Liu, Chuming You, Guifang Li, Hong Jiang, Hongping Rao, Jianwu Qiu, Xian Wei, Yayu Zhang, Xiaobo Lin, Haiyan Jiang, Shasha Han, Fan Wang, Xiufang Yang, Yitong Wang, Niyang Lin, Lizi Lin, Xinzhu Lin, Qiliang Cui

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引用次数: 0

Abstract

Background: Twin pregnancies, accounting for a rising proportion of births globally, present significant public health challenges in China. Birthweight discordance (BWD), a critical complication, remains understudied in its epidemiological context, particularly regarding its population-level associations with adverse neonatal outcomes.

Methods: This multi-center, retrospective cohort study leveraged data from 21 hospitals across 18 Chinese cities (2018-2020) to assess BWD and its epidemiological implications. Ordinal logistic regression with random effects was used to explore their association. BWD was defined as: [(larger birthweight - smaller birthweight) / larger birthweight] × 100% and categorized into four grades: I (≤15%), II (>15% to 20%), III (>20% to 25%), and IV (>25%).

Results: Among 6437 twin pairs, 73.6% were classified as Grade I (no BWD), while 10.7%, 7.1%, and 8.6% constituted Grades II, III, and IV discordance, respectively. Dose-response relationships emerged: each incremental BWD elevated risks of small vulnerable newborns (aOR = 1.83, 95% CI 1.76-1.90), small for gestational age (aOR = 1.23, 95% CI 1.18-1.29), low birthweight (LBW, aOR = 1.16, 95% CI 1.13-1.20), very LBW (aOR = 1.63, 95% CI 1.53-1.73) and extreme LBW (aOR = 1.82, 95% CI 1.61-2.05). Smaller twins exhibited disproportionately higher adverse outcome rates than larger twins. Sensitivity analyses confirmed robustness across specific subgroups.

Conclusion: BWD exceeding 20% affects 15.7% of live-born twins in China, mirroring rates in high-income settings. BWD demonstrates strong dose-response relationships with adverse outcomes, validating its utility for twin health stratification. These findings call for integrating BWD assessment into prenatal surveillance and risk-adapted care to reduce neonatal morbidity/mortality, urging clinicians and policymakers to prioritize perinatal outcome equity.

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中国活产双胞胎出生体重不一致与不良出生结局的关系：一项多中心研究。

背景：双胎妊娠在全球新生儿中所占比例不断上升，这给中国带来了重大的公共卫生挑战。出生体重不一致（BWD）是一种重要的并发症，在流行病学背景下仍未得到充分研究，特别是在人口水平上与新生儿不良结局的关联方面。方法：本多中心、回顾性队列研究利用2018-2020年中国18个城市21家医院的数据，评估BWD及其流行病学意义。采用随机效应的有序逻辑回归分析其相关性。BWD定义为：[（大出生体重-小出生体重）/大出生体重]× 100%，分为I级（≤15%）、II级（>15% ~ 20%）、III级（>20% ~ 25%）、IV级（>25%）四个等级。结果：在6437对双胞胎中，73.6%为I级（无BWD）， 10.7%、7.1%和8.6%分别为II、III和IV级不一致。出现了剂量-反应关系：体重每增加一次，小易感新生儿的风险增加（aOR = 1.83, 95% CI 1.76-1.90），胎龄小（aOR = 1.23, 95% CI 1.18-1.29），低出生体重（LBW, aOR = 1.16, 95% CI 1.13-1.20），非常低体重（aOR = 1.63, 95% CI 1.53-1.73）和极端LBW （aOR = 1.82, 95% CI 1.61-2.05）。较小的双胞胎比较大的双胞胎表现出不成比例的更高的不良后果发生率。敏感性分析证实了特定亚组的稳健性。结论：中国15.7%的活产双胞胎体重超过20%，这与高收入国家的情况相似。BWD显示了与不良结果的强烈剂量-反应关系，验证了其在双胞胎健康分层中的效用。这些发现呼吁将BWD评估纳入产前监测和风险适应护理，以降低新生儿发病率/死亡率，敦促临床医生和政策制定者优先考虑围产期结局公平。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Epidemiology Medicine-Epidemiology

CiteScore

6.30

自引率

5.10%

发文量

169

审稿时长

16 weeks

期刊介绍： Clinical Epidemiology is an international, peer reviewed, open access journal. Clinical Epidemiology focuses on the application of epidemiological principles and questions relating to patients and clinical care in terms of prevention, diagnosis, prognosis, and treatment. Clinical Epidemiology welcomes papers covering these topics in form of original research and systematic reviews. Clinical Epidemiology has a special interest in international electronic medical patient records and other routine health care data, especially as applied to safety of medical interventions, clinical utility of diagnostic procedures, understanding short- and long-term clinical course of diseases, clinical epidemiological and biostatistical methods, and systematic reviews. When considering submission of a paper utilizing publicly-available data, authors should ensure that such studies add significantly to the body of knowledge and that they use appropriate validated methods for identifying health outcomes. The journal has launched special series describing existing data sources for clinical epidemiology, international health care systems and validation studies of algorithms based on databases and registries.