Gestational hypertensive disease and small for gestational age infants in twin pregnancy: A systematic review and meta‐analysis

Abstract

Aim: The review is to explore the connection between gestational hypertension diseases (GHD) and small for gestational age (SGA) in twin pregnancies. Methods: According to the recommendations of PRISMA, relevant studies were systematically searched through PubMed, Web of Science, Cochrane Library, Embase from inception until January 16, 2022. Subgroup analysis was performed according to chorionicity and diagnostic criteria of SGA. Odds ratios (OR) were assessed to judge the link between GHD and SGA in twin pregnant women. A random-effect model was used to estimate the pooled hazard ratio when there was significant heterogeneity (I 2 > 50%); otherwise, a fixed-effect model was conducted. Results: Seven articles containing 470 589 twin pregnant women were included. The increased risk of SGA was connected to the twin pregnancies complicated with GHD (OR = 1.57, 95% confidence interval [CI] = 1.10-2.24, p = 0.01). After subgroup analysis, the connection between SGA and GHD had no statistical significance (OR = 1.17, 95% CI = 0.95-1.44, p = 0.14) when the enrolled studies using the SGA diagnosis referred to singleton birth weight, but significant (OR = 2.14, 95% CI = 1.77-2.60, p<0.001) in the group using the SGA diagnosis referred to twin birth weight. Stratified by chorionicity, SGA was relevant to GHD in the dichorionic (DC) group (OR = 1.68, 95% CI = 1.17-2.42, p = 0.005), while not in the monochorionic (MC) group (OR = 1.68, 95% CI = 0.93-3.03, p = 0.09). More future articles are warranted to confirm these outcomes. Conclusions: Our review demonstrated that GHD in DC twin pregnancies was related to an enlarged risk of SGA. Two SGA diagnosis references led to different results. Twin pregnancies complicated with GHD were at significantly higher risk of SGA when twin birth weight reference was used.

Twin charts should be the standard reference to assess growth in twin pregnancy

“…The comparatively asymmetrical growth pattern in twin pregnancies, where compared with singletons, growth lag is evident from around 30–32 weeks’ gestation, supports the concept that the intrauterine environment becomes constrained in its ability to sustain growth in twin foetuses [19]. When stratified by chorionicity, the association of hypertensive disorders of pregnancy and foetal growth restriction (FGR) is stronger in dichorionic than monochorionic twin pregnancies [20].…”

Impact of hypertensive disorders of pregnancy on maternal and neonatal outcomes of twin gestation: a systematic review and meta-analysis

“…For neonatal outcomes, HDP was found to increase the risk of low birth weight, SGA, and NICU admission but did not influence Apgar <7 scores. Recently, Wang et al ( 33 ) have also shown that HDP increases the risk of SGA in twin gestations. However, their review was restricted to only SGA, and only seven studies were included.…”