Association between hypertensive disorders and fetal growth restriction in twin compared with singleton gestations

Proctor, Leslie; Kfouri, Julia; Hiersch, Liran; Aviram, Amir; Zaltz, Arthur; Kingdom, John; Barrett, Jon; Melamed, Nir

doi:10.1016/j.ajog.2019.04.022

Cited by 52 publications

(69 citation statements)

References 39 publications

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“…The association between fetal growth disorders and the development of hypertension in twin pregnancies has been investigated, with evidence of conflicting results [ 8 , 9 , 10 , 11 , 12 , 13 ]. In small retrospective studies, the association between SGA and preeclampsia was not detected.…”

Section: Discussionmentioning

confidence: 99%

“…This was primarily because authors used singleton-based birthweight reference charts to define SGA, leading to a very high rate of SGA twins in both normotensive and hypertensive twin pregnancies [ 10 , 11 ]. Conversely, SGA was associated with an increased risk of preeclampsia in studies where a twin-specific birthweight chart was used [ 8 , 12 , 13 ]. In our study, SGA and FGR were associated with HDP using either singleton or twin charts; however, these associations were stronger when twin-specific charts were used.…”

Section: Discussionmentioning

confidence: 99%

“…Whereas the association between fetal growth anomalies and HDP has been well established in singleton pregnancies [ 7 ], several studies investigating this relationship in twin pregnancies have reported conflicting results [ 8 , 9 , 10 , 11 , 12 , 13 ]. Despite previous negative findings [ 10 , 11 ], Proctor et al demonstrated that the association between SGA and HDP in dichorionic twin pregnancies seems to be similar to that observed in singleton pregnancies when twin-specific birthweight references were used [ 8 ]. Moreover, a recent report has shown that discordant twins had a higher risk of preeclampsia, with a positive correlation with the degree of intertwin weight discordance [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Are Twin Pregnancies Complicated by Weight Discordance or Fetal Growth Restriction at Higher Risk of Preeclampsia?

Giorgione

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Bhate

et al. 2020

JCM

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Studies have reported controversial findings on the association between fetal growth restriction (FGR) or intertwin weight discordance and the risk of hypertensive disorders of pregnancy (HDP) in twin pregnancies. The aim of this study was to investigate the association between twin growth disorders and HDP. Twin pregnancies resulting in two live births at St George’s Hospital between 2000 and 2019 were included. FGR or small-for-gestational-age (SGA) at birth was assessed using singleton and twin reference charts. Intertwin discordance [(large birthweight − small birthweight)/(large birthweight) × 100%)] was calculated. Logistic regression models were performed. SGA (aOR 2.34, 95% CI 1.60–3.44, p < 0.001), intertwin discordance ≥25% (aOR 2.10, 95% CI 1.26–3.49, p = 0.004) and their co-existence (aOR 2.03, 95% CI 1.16–3.54, p = 0.013) were significantly associated with HDP. After adjusting for the known maternal risk factors of HDP and the intertwin discordance, SGA (using the twin charts) was the strongest independent risk factor associated with HDP (aOR 2.12, 95% CI 1.40–3.22, p < 0.001) and preeclampsia (aOR 2.34, 95% CI 1.45–3.76, p < 0.001). This study highlights that the presence of at least one SGA twin is significantly associated with HDP during pregnancy. Therefore, maternal blood pressure should be closely monitored in twin pregnancies complicated by SGA with or without intertwin discordance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Are Twin Pregnancies Complicated by Weight Discordance or Fetal Growth Restriction at Higher Risk of Preeclampsia?

Giorgione

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et al. 2020

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“…Few studies looked at the association of twin-specific growth standards with clinical adverse outcomes [ 8 , 18 ]. The findings of the study by Kalafat et al have suggested that twin-specific growth standards could identify the same number of twin pregnancies with SGA and stillbirth as the singleton charts, while labeling fewer pregnancies with liveborn fetuses as complicated with growth abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…Recent evidence has demonstrated that the use of twin-specific charts better identifies the pregnancies at increased risk of adverse perinatal outcome [ 18 , 19 ]. However, there is a general reluctance to take up their use into routine clinical practice, as the use of twin charts is still considered controversial.…”

Section: Introductionmentioning

confidence: 99%

The Association Between Hypertension in Pregnancy and Preterm Birth with Fetal Growth Restriction in Singleton and Twin Pregnancy: Use of Twin Versus Singleton Charts

Kalafat

Abiola

Thilaganathan

et al. 2020

JCM

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Objective: To compare the rates of fetal growth restriction (FGR) in singleton and twin pregnancies using singleton and twin-specific birthweight standards. Methods: The study included liveborn twin and singleton pregnancies between January 2000 and January 2019. Hypertensive disorders of pregnancy (HDP) included gestational hypertension and pre-eclampsia. The study outcomes were FGR or small-for-gestational-age (SGA) at birth as assessed using singleton and twin reference charts. Results: The analysis included 1473 twin and 62,432 singleton pregnancies. In singleton pregnancies the risk of PTB <34 weeks without HDP (OR 2.82, p < 0.001), delivery ≥34 weeks with HDP (OR 2.38, p < 0.001), and PTB <34 weeks with HDP (OR 13.65, p < 0.001) were significantly higher in the pregnancies complicated by FGR compared to those without. When selective fetal growth restriction (sFGR) was assessed using the singleton standard, the risk of PTB <34 weeks without HDP (OR 1.03, p = 0.872), delivery ≥34 weeks with HDP (OR 1.36, p = 0.160) were similar in the pregnancies complicated by sFGR compared to those without, while the risk of PTB <34 weeks with HDP (OR 2.41, p = 0.025) was significantly higher in the pregnancies complicated by sFGR compared to those without. When sFGR was assessed using the twin-specific chart, the risk of PTB <34 weeks without HDP (OR 3.55, p < 0.001), delivery ≥34 weeks with HDP (OR 3.17, p = 0.004), and PTB <34 weeks with HDP (OR 5.69, p < 0.001) were significantly higher in the pregnancies complicated by sFGR compared to those without. The stronger and more consistent association persisted in the subgroup analyses according to chorionicity. The strength of association in dichorionic twin pregnancies resembles that of the singletons more closely and consistently when the FGR was diagnosed using the twin-specific charts. Conclusion: FGR in twin pregnancies has a stronger and more consistent association with HDP and PTB when using twin-specific rather than singleton charts. This study provides further evidence supporting the use of twin-specific charts when assessing fetal growth in twin pregnancies.

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Association of Elevated Maternal Serum Total Bile Acids With Low Birth Weight and Intrauterine Fetal Growth Restriction

Song

Chen²,

Chen

et al. 2021

JAMA Netw Open

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IMPORTANCE Bile acids play essential roles in metabolic modulation. Excessive serum total bile acid (sTBA) levels during pregnancy are associated with adverse perinatal outcomes; however, their association with the risk of intrauterine growth restriction (IUGR) remains unclear. OBJECTIVE To investigate the association between maternal sTBA concentration during pregnancy and the risk of IUGR. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included pregnant individuals who delivered live singleton neonates and had regular antenatal examination records available at a hospital-based center in Shanghai, China, from 2014 to 2018. Data were analyzed from July to November 2020. EXPOSURES Maternal sTBA concentration during pregnancy. MAIN OUTCOMES AND MEASURES Fetal birth weight and probability of low birth weight (LBW) and IUGR. RESULTSThis study included 68 245 singleton pregnancies with live births for analysis. The mean (SD) age of the pregnant individuals was 30.5 (3.8) years, 67 168 patients (98.4%) were Han, and 50 155 (73.5%) were nulliparous. Nonlinear regression models suggested that there was an inverted J-shaped association between maternal sTBA level during pregnancy and fetal birth weight, with a steep decrease in birth weight at high sTBA levels (estimated mean [SE] birth weight for sTBA of 40.8 ug/mL, 2879 [39.9] g) and greater birth weights at lower sTBA levels (estimated mean [SE] birth weight for sTBA 0.4 μg/mL, 3290 [3.9] g; and for 4.1 μg/mL, 3334 [1.6] g). Lower birth weight and a higher incidence of IUGR were observed in patients with gestational hypercholanemia (sTBA Ն4.08 μg/mL) compared with those without gestational hypercholanemia (birth weight: estimated adjusted mean [SE], 3309 [3.32] vs 3338 [0.80] g; P = .005; incidence of IUGR: 62 of 4467 [1.4%] vs 312 of 63 778 [0.5%]; P < .001). Moreover, compared with patients with sTBA concentrations of less than 4.08 μg/mL, those with gestational hypercholanemia had an increased risk of LBW (adjusted odds ratio [aOR], 1.29; 95% CI, 1.09-1.53) and IUGR (aOR, 2.18; 95% CI, 1.62-2.91). In addition, there was an additive interaction between hypertensive disorders in pregnancy (HDP) and hypercholanemia on LBW and IUGR risk. The highest risks of LBW and IUGR were found in pregnant individuals with both HDP and hypercholanemia compared with those with normotensive pregnancies with sTBA concentrations less than 4.

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Association between hypertensive disorders and fetal growth restriction in twin compared with singleton gestations

Cited by 52 publications

References 39 publications

Are Twin Pregnancies Complicated by Weight Discordance or Fetal Growth Restriction at Higher Risk of Preeclampsia?

Are Twin Pregnancies Complicated by Weight Discordance or Fetal Growth Restriction at Higher Risk of Preeclampsia?

The Association Between Hypertension in Pregnancy and Preterm Birth with Fetal Growth Restriction in Singleton and Twin Pregnancy: Use of Twin Versus Singleton Charts

Association of Elevated Maternal Serum Total Bile Acids With Low Birth Weight and Intrauterine Fetal Growth Restriction

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