출산 연령에 따른 쌍태아의 출생체중 불일치 수준
The Relationship between Maternal Age at Birth and Intertwin Birth Weight Discordance in Korea
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
본 연구자료는 통계청의 2007~2014년간 총 3,701,806건의 출생자료 중에서 서로 쌍을 이룬 쌍태아 51,726쌍을 대상으로 출산 연령에 따른 출생체중 중증불일치 수준(25% 이상) 발생 위험도 추정을 위해 다항로지스틱 회귀분석을 하였다. 쌍태아 중 더 무거운 쌍태아의 평균 출생체중은 2.536 kg, 가벼운 출생아의 평균체중은 2.254 kg이었으며, 출생체중 차이는 평균 0.282 kg이었다. 쌍태아의 평균 출생체중 불일치율은 11.0%였으며, 출산 연령 20~29세군은 10.5%, 30~34세군 11.0%, 35세 이상군은 11.4%였다. 출생체중 불일치 수준 10% 미만의 발생률은 55.1%, 불일치 수준 20~29%, 불일치 수준 30% 이상은 각각 10.9%, 4.4%였고, 출산 연령이 증가함에 따라 불일치 수준 20~29% 및 30% 이상의 발생률이 증가하였다. 출생체중 중증불일치 수준 발생률은 출산 연령 20~29세군이 7.7%, 30~34세군 8.3 %, 35세 이상군이 8.7%로 출산 연령이 증가함에 따라 발생률이 증가하였다(p<0.05). 출산 연령별 중증불일치 수준 발생 위험도를 출생년도, 부의 연령, 출생아의 성, 교육수준, 임신기간의 변수를 이용하여 로지스틱 회귀분석 결과 출산 연령 20~29세군에 비해 30~34세군의 중증불일치 수준 발생 위험도는 1.094 (95% 신뢰구간: 1.005~1.190), 35세 이상군은 1.164 (1.401~ 1.301)로 통계적으로 유의하였다. 출산 연령과 쌍태아의 성 구조를 서로 통합한 불일치 수준에서 동일 성 구조에 비해 다른 성 구조에서 중증불일치 수준 발생 위험도가 모든 연령군에서 교차비가 증가하였다(p<0.01). 본 연구결과 출산 연령이 증가함에 따라 쌍태아 출생체중 중증불일치 수준의 위험도가 증가하였고, 서로 다른 성구조에서 위험도가 더 크게 나타났다.
Abstract
Purpose: To compare the relationship between intertwin birth weight discordance and maternal age at birth. Methods: There were 51,726 pairs of twins born from 2007 to 2014 according to the birth certificate data of Korea Statistics (3,701,806 births). The data were excluded due to extra marital births, home births, and teenage births. Birth weight discordance rate (%) was calculated according to the following formula: (larger birth weight - smaller birth weight)/(birth weight of the larger twin) ×100. The odds ratio of intertwin birth weight discordance rate (≥25%) in maternal age at birth was calculated by logistic regression adjusted by the year of birth, gestational age, maternal education, infantile gender and paternal age. Results: The mean birth weight of the heavier twin and that of the lighter twin were 2.536 kg and 2.254 kg, respectively. The mean birth weight difference of intertwins was 0.282 kg. The mean birth weight discordance rate by maternal age was 10.5 percent for maternal ages between 20 and 29 years, 11.0 percent for between 30 and 34 years, and 11.4 percent for 35 years and older. The frequency of birth weight discordance level of ≥25 percent increased as the maternal age increased. The rate of birth weight discordance (≥25%) was 7.7 percent for maternal ages between 20 and 29 years, 8.3 percent for between 30 and 34 years, and 8.7 percent in for 35 years and older. Compared with women from 20 to 29 years of age, the odds ratio of ≥25 percent discordance was 1.094 (95% confidence interval: 1.005~1.190) for 30 to 34 years, and 1.164 (1.401~ 1.301) for 35 years and older. The odds ratio of ≥25 percent discordance for the different-sexed twins was higher than that of the same-sexed twins in overall maternal age groups of 20 to 29 years, 30 to 34 years, and 35 years and older. Conclusion: The risk of birth weight discordance level of ≥25 percent was associated with the older maternal age. More research is required to understand the risk factors of intertwin birth weight discordance for older women.
참고문헌 (28)
- Blickstein I, "The relation between inter-twin birth weight discordance and total twin birth weight", Obstet Gynecol, 93(1), pp.113~116 (1999)
- Blickstein I, "Birthweight discordance in multiple pregnancy", Twin Res, 6(6), pp.526~531 (2003)
- Cohen W, "Does maternal age affect pregnancy outcome?", BJOG, 121(3), pp.252~254 (2014)
- Demissie K, "Fetal and neonatal mortality among twin gestations in the United States:the role of intrapair birth weight discordance", Obstet Gynecol, 100(3), pp.474~480 (2002)
- 길기철, "융모막성에 따른 쌍태아 체중 불일치의 주산기 예후", Obstetrics & Gynecology Science, 51(11), pp.1262~1268 (2008), 대한산부인과학회
- 김나옥, "임신 주수별 쌍태아의 출생 체중 분포", Obstetrics & Gynecology Science, 47(10), pp.1859~1864 (2004), 대한산부인과학회
- 임지은, "출생시 쌍태아간의 체중 차이에 따른 예후 비교", Obstetrics & Gynecology Science, 46(3), pp.1~1 (2003), 대한산부인과학회
- Liu Q, "Change trend of birth weight of twins in China, 1995-2012", Zhonghua Liu Xing Bing Xue Za Zhi, 36(2), pp.115~118 (2015)
- Martin JA, "Three decades of twin births in the United States, 1980-2009", NCHS Data Brief, (80), pp.1~8
- "Hyattsville. MD. National Center for Health Statistics", ~ (2012)
- "Statistics Korea"[URL]
- Miller J, "Discordant twins: diagnosis, evaluation and management", Am J Obstet Gynecol, 206(1), pp.10~20 (2012)
- Mottet N, "Birth weight discordance in dichorionic twins: diagnosis, obstetrical and neonatal prognosis", Gynecol Obstet Fertil, 42(9), pp.572~578 (2014)
- Park SH, "Secular on trends of twin births in Korea; 1981-2006", J Reprod Med Popul, 22, pp.152~158 (2009)
- 박상화, "우리나라 쌍태아의 출생체중 불일치 수준과 조기분만에 관한 연구; 2009-2013", 보건정보통계학회지, 40(2), pp.22~30 (2015), 한국보건정보통계학회
- 박상화, "출산 연령 구조가 조기분만율에 미치는 기여효과: 단태아 출생통계 중심으로, 1997~99, 2012~14", 한국모자보건학회지, 20(3), pp.221~227 (2016), 한국모자보건학회
- Park SH, "The birth weight discordance of inter-twin in Korea", J Reprod Med Popul, 28, pp.103~110 (2015)
- Park SH, "Secular tends of age specific multiple birth rate in Korean women;1998-2010", J Reprod Med Popul, 25, pp.95~103 (2012)
- Park SH, "Contribution of maternal age distribution to incidence of multiple birth rate; 1997-99 and 2011-13", J Reprod Med Popul, 28, pp.96~102 (2015)
- 박상화, "우리나라 쌍태아의 성별, 출생순위별 출생체중 불일치 수준에 관한 연구; 2008-2013", Perinatology, 26(3), pp.229~236 (2015), 대한주산의학회
- Redman ME, "The ninety-fifth percentile for growth discordance predicts complications of twin pregnancy", Am J Obstet Gynecol, 187(3), pp.667~671 (2002)
- Sannoh S, "Risk factors for intrapair birth weight discordance in twins", J Matern Fetal Neonatal Med, 13(4), pp.230~236 (2003)
- Tan H, "The distribution of intra-twin birth weight discordance and its association with total twin birth weight, gestational age, and neonatal mortality", Eur J Obstet Gynecol Reprod Biol, 121(1), pp.27~33 (2005)
- Tandberg A, "Increasing twinning rates in Norway, 1967-2004:the influence of maternal age and assisted reproductive technology (ART)", Acta Obstet Gynecol Scand, 86(7), pp.833~839 (2007)
- Tobe RG, "Birthweight discordance, risk factors and its impact on perinatal mortality among Japanese twins: data from a national project during 2001-2005", Twin Res Hum Genet, 13(5), pp.490~494 (2010)
- Vergani P, "Preterm twins: what threshold of birth weight discordance heralds major adverse neonatal outcome?", Am J Obstet Gynecol, 191(4), pp.1441~1445 (2004)
- Wen SW, "Prediction of intra-twin birth weight discordance by binary logistic regression analysis", Gynecol Obstet Invest, 62(4), pp.186~192 (2006)
- Yang SH, "A comparison of perinatal outcomes according to the degrees of birth weight discordance in twin gestations", Korean J Obstet Gynecol, 41(9), pp.2312~2317 (1998)