Hypertensive disorders of pregnancy and neonatal outcomes in twin vs. singleton pregnancies after assisted reproductive technology

Abstract

ObjectiveHypertensive disorders of pregnancy (HDP) are associated with an increased risk of adverse neonatal outcomes. Although twin pregnancies had a higher risk of developing HDP, it is not known whether HDP in twins will increase the risk of adverse neonatal outcomes. We aimed to assess whether this association differed in singleton and twin pregnancies in women who conceived with assisted reproductive technology (ART).MethodsWe finally included 193,590 live births born via ART from the National Vital Statistics System (NVSS) for the years 2015–2019. We used Log-binomial regression to evaluate the associations between HDP and the risk of adverse neonatal outcomes in ART mothers.ResultsAmong 193,590 ART-treated mothers, there were 140,870 and 52,720 mothers who had singleton pregnancies and twin pregnancies, respectively. Those ART mothers with twin pregnancies had a higher rate of HDP than singleton pregnancies (20.5% vs. 11.0%). In singleton pregnancies, the risks of preterm birth [adjusted risk ratio (aRR)): 2.80, 95% CI 2.67–2.93], low birth weight (aRR: 2.80, 95% CI 2.67–2.93), small for gestational age (aRR: 1.41, 95% CI 1.34–1.49), 5 min Apgar <7 (aRR: 1.66, 95% CI 1.50–1.83) and cesarean section (aRR: 1.23, 95% CI 1.21–1.25) were significantly higher in HDP mothers than in non-HDP mothers respectively. However, in contrast to singleton pregnancies, these associations were weak or reversed in twin pregnancies, after adjusting for confounding factors.ConclusionIn ART-treated women, although twin pregnancies had a higher HDP rate, the risk of adverse neonatal outcomes associated with HDP was lower than that of singletons.

Hypertensive disorders of pregnancy and adverse outcomes of twins

“…Previous studies have also con rmed an elevated risk of low Apgar scores in singleton infants affected by HDP, [27,53] although the impact on twin pregnancies may be less pronounced. [54] Importantly, our ndings revealed that HDP increased the risk of low Apgar scores, with preeclampsia having a more signi cant effect on twin infants compared to gestational hypertension. [55] The underlying pathophysiology is believed to involve placental dysfunction, which hampers fetal growth and subsequently impacts Apgar scores.…”

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

“…All articles were published between 2012 and 2022. Six of the studies ( 9 , 10 , 16 , 17 , 20 , 21 ) were from North America (USA or Canada) ( Table 1 ). The remaining were from Slovenia ( 15 ), Italy ( 11 ), the UK ( 22 ), Ireland ( 18 ), and China ( 19 ).…”

“…The remaining were from Slovenia ( 15 ), Italy ( 11 ), the UK ( 22 ), Ireland ( 18 ), and China ( 19 ). One study ( 9 ) included only assisted reproductive technology-based gestations, while all others ( 10 , 11 , 22 , 14 – 21 ) included natural conception as well. Seven studies ( 9 , 10 , 16 , 18 , 20 – 22 ) included twin pregnancies with gestational hypertension and preeclampsia.…”

“…One study ( 9 ) included only assisted reproductive technology-based gestations, while all others ( 10 , 11 , 22 , 14 – 21 ) included natural conception as well. Seven studies ( 9 , 10 , 16 , 18 , 20 – 22 ) included twin pregnancies with gestational hypertension and preeclampsia. Three studies ( 11 , 14 , 17 ) included only gestational hypertension and two ( 15 , 19 ) included only preeclampsia.…”

Potential Impact on Using Aspirin as the Primary Prevention of Adverse Pregnancy Outcomes in Twins conceived using ART: A Retrospective Case-Control Study in A Tertiary Hospital

“…Aspirin alone may not be able to reverse this problem. Even if ART does not increase major obstetric complications and perinatal risk in twin pregnancies [33], women who need ART may have underlying problems themselves that increase the risk of adverse pregnancy outcomes. This may also be why aspirin does not have the desired overall effect.…”