【摘要】 目的 使用Z评分法评估辅助生殖技术(ART)助孕成功的双胎妊娠妇女孕期孕周别增重及对不良妊娠结局的影响。方法 整群抽样选取甘肃省妇幼保健院围产医学门诊无基础代谢性疾病史并通过ART助孕成功的双胎妊娠孕妇作为研究对象，建立ART孕产妇队列，开展孕中期生活行为问卷调查，随访孕期体重增长变化，并记录孕检情况、并发症及妊娠结局。将双胎妊娠体重增重(kg)转换为孕龄标准化Z评分，将Z评分值依据<-1、-1～+1、>1分为增重不足、增重适宜、增重过多三组进行比较，采用Logistic回归模型进行基于Z评分分类法的增重对不良妊娠结局的影响评估。结果 共纳入ART双胎妊娠妇女841例，对基础体重适宜的双胎孕妇而言，经Logistic回归分析显示，在控制混杂因素后，孕期增重不足(Z评分<-1)是剖宫产(OR=0.39,95%CI:0.17～0.92)、妊娠高血压综合征(OR=0.29,95%CI:0.09～0.97)的保护性因素，是早产(OR=3.12,95%CI:1.53～6.38)、出生体重<2 500 g(OR=2.06,95%CI:1.16～3.68)的危险因素；而ART双胎孕妇孕期增重过多(Z评分>1)是胎膜早破(OR=2.05,95%CI:1.09～3.84)、早产(OR=2.49,95%CI:1.38～4.50)、妊娠高血压综合征(OR=2.92,95%CI:1.66～5.31)的危险因素。结论 Z评分作为新指标可用于国内评价基础体重适宜的双胎妊娠妇女孕期增重，当Z评分<-1或Z评分>1时，不良妊娠结局风险显著增加，Z评分法便捷可靠、易于临床推广。更多还原

【Abstract】 Objective To evaluate the effect of gestational weight gain(GWG) Z-score on adverse pregnancy outcomes of twin pregnancy women who have succeeded in assisted reproductive technology(ART). Methods A prospective ART maternal cohort established, twin pregnant women who conceived by ART and had no history of basal metabolic diseases were selected from the Perinatal Medicine Center of Gansu Province Maternal and Child Health Hospital. The mid-trimester life behavior questionnaire was investigated, and GWG, record pregnancy examination, complications and pregnancy outcomes were surveyed in follow-up. GWG(kg) is converted into the standardized Z score according to gestational age, and is divided into three groups: insufficient weight gain, appropriate weight gain, and excessive weight gain as Z score <1,-1 to +1, >1. The Logistic regression was used to evaluate the influence of GWG Z-score on adverse pregnancy outcomes. Results A total of 841 women with ART twin pregnancy were included. After controlled confounding factors, the insufficient GWG(Z score <-1) is the protective factor for cesarean section(OR=0.39, 95%CI:0.17-0.92) and pregnancy-induced hypertension(OR=0.29, 95% CI:0.09-0.97), and is the risk factor for preterm birth(OR=3.12, 95%CI:1.53-6.38) and the low average birth weight(OR=2.06, 95%CI:1.16-3.68). The sufficient GWG(Z score >1) is the risk factor for premature rupture of membranes(OR=2.05, 95%CI:1.09-3.84), premature delivery(OR=2.49, 95%CI:1.38-4.50), and pregnancy-induced hypertension(OR=2.92, 95%CI:1.66-5.31). Conclusion Z score can be used as a new indicator to evaluate the GWG of Chinese twin pregnancy women with suitable basic weight. When Z score <-1 or Z score>1, the risk of adverse pregnancy outcomes increased significantly. The Z score method is convenient, reliable, and easy to clinically use.更多还原