{"id":130,"title":"Impact of gestational diabetes mellitus and assisted reproductive technology on maternal and neonatal outcomes in twin pregnancies: A multicentre retrospective study in China","title_zh":"妊娠期糖尿病与辅助生殖技术对双胎妊娠母婴结局的影响：中国多中心回顾性研究","url":"https://pubmed.ncbi.nlm.nih.gov/42965900","doi":"10.1111/dme.70512","pmid":"42965900","journal":"Diabet Med","kind":"paper","lang":"en","published_at":"2026-10-31T00:00:00+00:00","fetched_at":"2026-11-08T03:43:53+00:00","authors":["Zhou LY","Wu XB","Wang YQ","Hao Y","Yao YL","Liu RL","Xu Z","Ye K","Chen XY","Ding YB"],"primary_topic":"art-clinical","topics":[{"slug":"art-clinical","score":4.0,"hits":["assisted reproductive"]},{"slug":"early-pregnancy","score":2.0,"hits":["birth weight","preterm birth"]},{"slug":"endometrium","score":1.0,"hits":["placental"]}],"topic_score":4.0,"preference_score":0.0,"preference_labels":[],"llm_score":76.0,"final_score":76.0,"score_dims":{"novelty":68,"rigor":82,"impact":72,"relevance":88,"translation":78},"recommend_reason":"样本量较大、多中心设计，并同时评估相乘与相加交互；但新意有限，交互仅在<34周早产这一结局上显著，提示风险差异具有结局特异性。对双胎妊娠的产前风险分层与ART临床管理有直接参考价值。","keywords":["双胎妊娠","辅助生殖技术","妊娠期糖尿病","早产","交互作用","母婴结局"],"selected":1,"story_id":252,"llm_provider":"deepseek","llm_model":"deepseek-flash","llm_effort":"low","source_key":"pubmed-art","source_name":"PubMed · 辅助生殖临床","source_tier":1,"mention_count":1,"has_interpretation":false,"journal_key":null,"journal_tier":"unknown","journal_if":null,"is_mock":false,"summary_zh":"本研究为三中心回顾性队列，纳入4522例活产双胎妊娠，按受孕方式与妊娠期糖尿病（GDM）状态分组，用广义线性混合模型（医院为随机效应）估计校正OR，并做相乘与相加交互分析。结果显示，GDM总患病率为22.2%（ART组30.0%，自然妊娠组14.0%）；与无GDM的自然妊娠双胎相比，ART受孕合并GDM者胎盘粘连、剖宫产、<37周早产及低出生体重的风险显著升高。<34周早产存在显著的相乘（aOR 1.76）与相加（RERI 0.55）交互，其余结局未见统计学交互。作者认为共存风险的超额部分具有结局特异性，有助于双胎妊娠风险分层与产前监测。","summary":"AIMS: Twin pregnancies are inherently at high risk of maternal and neonatal complications. Assisted reproductive technology (ART) and gestational diabetes mellitus (GDM) are both common in this population, but it remains unclear whether their coexistence is associated with excess risk beyond their individual associations. METHODS: In this multicentre retrospective cohort of 4522 liveborn twin pregnancies across three hospitals in China, pregnancies were categorized according to mode of conception and GDM status. Generalized linear mixed models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs), with hospital included as a random effect. Multiplicative and additive interaction analyses were performed to assess whether the joint associations of ART and GDM with maternal and neonatal outcomes exceeded their individual associations. RESULTS: The overall prevalence of GDM was 22.2%, with 30.0% in ART-conceived women and 14.0% in spontaneously conceived (SC) women. Compared to SC twin pregnancies without GDM, ART-conceived twin pregnancies with GDM showed significantly increased risks of placental adhesion (aOR: 1.55; 95% CI: 1.03-2.33), caesarean section (aOR: 2.72; 95% CI: 1.21-6.15), preterm birth <37 weeks (aOR: 1.43; 95% CI: 1.15-1.78) and low birth weight (aOR: 1.27; 95% CI: 1.01-1.60). Notably, statistically significant multiplicative (aOR: 1.76; 95% CI: 1.11-2.80) and additive (relative excess risk due to interaction: 0.55; 95% CI: 0.14-0.96) interactions between GDM and ART were observed for preterm birth <34 weeks, whereas no statistically significant interactions were detected for the other examined outcomes. CONCLUSION: Twin pregnancies with both ART conception and GDM had higher risks of several adverse outcomes than spontaneously conceived pregnancies without GDM. However, evidence of statistical interaction between ART and GDM was limited to preterm birth <34 weeks, suggesting that the excess risk associated with their coexistence may be outcome-specific. These findings may help refine risk stratification and prenatal surveillance in twin pregnancies.","interpretation_basis":null,"fulltext_status":null,"interpretation":null,"fulltext":{"available":false,"status":null,"reason":"尚未抓取全文（未入选、分数未达阈值，或还没跑 fulltext 步骤）","pmcid":null,"license":null,"chars":0,"source":null,"fetched_at":null}}