ObjectivesThe aim of this study was to assess the prevalence and risk of pre-eclampsia and gestational hypertension in twin pregnancies compared with singleton pregnancies.DesignPopulation-based cohort study.SettingMedical Birth Registry of Norway and Statistics Norway.Participants929 963 deliveries with 16 174 twin pregnancies in 1999–2014.MethodsPre-eclampsia prevalences in twin and singleton pregnancies were described in percentages. Multivariable regression analyses were performed to assess the risks of pre-eclampsia and gestational hypertension in twin pregnancies compared with those in singleton pregnancies, adjusted for previously known risk factors.Primary and secondary outcome measuresPrevalence and risk of pre-eclampsia and gestational hypertension.ResultsThe prevalence of pre-eclampsia in the study population was 3.7% (3.4% in singleton pregnancies, 11.8% in twin pregnancies (p=0.001)). The OR for pre-eclampsia in twin pregnancies was three to fourfold compared with singleton pregnancies (OR 3.78; 95% CI 3.59 to 3.96). After adjustment for known risk factors, twin pregnancy remained an independent risk factor for pre-eclampsia (adjusted OR 4.07; 95% CI 3.65 to 4.54). The prevalence of gestational hypertension was 1.7% in women with singleton pregnancies and 2.2% in those with twin pregnancies (OR 1.27; 95% CI 1.14 to 1.41). After adjustment for known risk factors, gestational hypertension was not significantly associated with twin pregnancy.ConclusionsThe risk of pre-eclampsia in twin pregnancies was three to fourfold compared with singleton pregnancies, regardless of maternal age, parity, educational level, smoking, maternal comorbidity or in vitro fertilisation. The risk of gestational hypertension was not increased in women with twin pregnancies after adjustment for the main risk factors.

Maternal country of birth and education were associated with HDP. Women with higher education had the lowest risk of HDP, and Norwegian-born women had the highest risk of HDP, regardless of parity and other confounding factors.

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BackgroundDespite its commonality, there is a paucity of literature on miscarriage in non-Western societies. In particular, there is little understanding of how people ascribe cause to miscarriage. This research sought to gain an in-depth understanding of notions of miscarriage causality and risk amongst Qataris.MethodsThe study adopted an exploratory descriptive qualitative approach and collected data during 18 months of ethnographic research in Qatar, including semi-structured interviews. The sample includes 60 primary participants (20 pregnant women and 40 women who had recently miscarried), and 55 secondary participants including family members, health care providers, religious scholars and traditional healers. Informed consent was obtained from all participants. Primary participants were interviewed in Arabic. The interviews were audio recorded, transcribed and translated into English. Data was analysed using an inductive thematic approach, which involved identification and application of multiple codes to different text segments. Data were encoded manually and examined for recurrences across the data set. Similar quotations were grouped into subcategories and further categorized into main themes.ResultsA number of key themes emerged, revealing Qatari women attributed miscarriages to a number of factors including: supernatural forces, such as God’s will and evil eye; lifestyle, such as physical activities and consuming particular substances; medical conditions, such as diabetes; and emotional state, such as stress, and emotional upset. Resting, avoiding stress and upset, maintaining healthy diet, and spiritual healing (ruqyah) are seen as a means to avoid miscarriage.ConclusionPractices and beliefs around miscarriage are embedded in social, cultural, religious and medical frameworks. Understanding the socio-cultural context and understandings of explanatory theories can enhance health care providers’ understandings, resulting in improved communication and care.

This paper explores emerging themes from the first stage of ethnographic research investigating pregnancy and loss in Qatar. Issues around the development of foetal personhood, the medical management of the pregnant body and the social role of the pregnant woman were explored. Findings suggest that Qatari women are expected to be calm vessels for their growing baby and should avoid certain foods and behaviours. These ideas of risk avoidance are linked to indigenous knowledge around a mother's influence on a child's health and traits. Motherhood holds a particularly important place in Qatari culture and in Islam and women are ultimately responsible for protecting and promoting fertility and for producing healthy children.