Is gestational hypertension beneficial in twin pregnancies?

Ferrazzani, Sergio; Moresi, Sascia; Feo, Emma De; Degennaro, Valentina Anna; Salvi, Silvia; Boccia, Stefania; Lanzone, Antonio; Carolis, Sara De

doi:10.1016/j.preghy.2015.01.003

Cited by 9 publications

(18 citation statements)

References 9 publications

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“…The relatively small sample size in twins limited our ability to draw conclusions on this aspect; nevertheless, the results suggest that, at least until week 27, estimates in twins may be less susceptible to how size at birth is modeled. This conclusion is supported by the fact that, in twins, MH has limited impact on fetal growth, 10,21,23,24 even among very preterm births. 22 The main strengths of this study are the large sample size, the fact that we were able to examine a span of several years over a recent period, and the standardized data collection protocol for all participating hospitals.…”

Section: Discussionmentioning

confidence: 84%

“…Several studies have suggested that, overall, twins born after MH have better outcomes than twins born from normotensive pregnancies. 2,10,14,[21][22][23][24] These observations have led to the hypothesis that gestational hypertension may be an adaptive condition in multifetal pregnancies. 2,10,14,22,23 Three reports have suggested that, among very preterm twins, gestational hypertension is associated with lower mortality.…”

Section: Introductionmentioning

confidence: 99%

“…2,10,14,[21][22][23][24] These observations have led to the hypothesis that gestational hypertension may be an adaptive condition in multifetal pregnancies. 2,10,14,22,23 Three reports have suggested that, among very preterm twins, gestational hypertension is associated with lower mortality. 2,10,14 These studies were all based on data from US birth certificates using different time periods, inclusion criteria, analyses, and relatively broad categories of GA at birth, comprising 9 or more weeks (20-28 or 20-31 weeks).…”

Section: Introductionmentioning

confidence: 99%

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Maternal hypertension and survival in singletons and twins born at 23–29 weeks: not just one answer…

Gagliardi

Basso

2019

Pediatr Res

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BACKGROUND: To describe the association between maternal hypertension (chronic and gestational, MH) and mortality in very preterm singletons and twins, focusing on how estimates depend on gestational age (GA) and size at birth. METHODS: We estimated relative risks of in-hospital death in 12,320 singletons (MH: 22.4%) and 4381 twins (MH: 10.6%) born at 23-29 weeks in the Italian Neonatal Network (89 hospitals, 2008-2016). RESULTS: Babies with MH had higher GA and were more frequently small-for-gestational age (SGA), especially singletons. In crude analyses, MH was associated with lower mortality in singletons. In multivariable analyses, the effects of GA and size differed between twins and singletons with and without MH. The best-fitting models included continuous birth weight (rather than SGA) and were stratified by GA. In these models, MH was associated with lower mortality in singletons-but not twins-born after week 25. CONCLUSIONS: In this cohort of very preterm infants, the association between MH and mortality differed between singletons and twins and across strata of GA at birth. These estimates cannot be interpreted causally, but suggest that, from a descriptive/ predictive standpoint, singletons with MH born after week 25 have lower mortality than singletons born to women without MH.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Maternal hypertension and survival in singletons and twins born at 23–29 weeks: not just one answer…

Gagliardi

Basso

2019

Pediatr Res

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“…In 2006, a retrospective cohort study by Luo et al investigated 102,988 twin pregnancies compared to 5,523,797 singletons and found that gestational hypertension in twin pregnancies had overall better neonatal outcomes in terms of rate of preterm delivery, intrauterine growth restriction, neonatal death, and APGAR score (28). Two additional studies also reported that gestational hypertension in twin pregnancies is not detrimental to fetal growth, or even gestational hypertension can be beneficial for fetal survival in twin pregnancies, as compared to normotensive ones (33,34). A more recent study by Aviram et al revealed a similar pattern.…”

Section: Discussionmentioning

confidence: 84%

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

et al. 2022

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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.

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“…However, results from a relevant study were different, indicating that weight discordance was similar between the gestational hypertension and normotension groups in twin pregnancies. In addition, gestational hypertension may play a beneficial role in physiological processes and provided a better placental perfusion in twin pregnancies [34] . According to these results, we thought the physiological mechanism of gestational hypertension might be unclear in twin pregnancies, so we excluded this subgroup in the present study.…”

Section: Discussionmentioning

confidence: 96%

Clinical characteristics of fetal and neonatal outcomes in twin pregnancy with preeclampsia in a retrospective case–control study

Tan

Wang²,

Li³

et al. 2016

Medicine

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The aim of our study was to compare the clinical characteristics of fetal and neonatal outcomes in twin pregnancies between women with preeclampsia (PE) and those with normotension in a Chinese population.There were 143 preeclamptic women and 367 normotensive women with twin pregnancies included in this retrospective case–control study. The baseline characteristics and perinatal outcomes were collected and compared between the groups. Multiple logistic regression and linear regression were used to assess the correlations between PE and the outcomes.Significant increases were observed in the frequencies of preterm delivery (OR = 2.75, P < 0.001), iatrogenic preterm birth (OR = 3.52, P < 0.001), and IUGR (OR = 2.94, P = 0.001) in the PE group, and the PE group had more than a 2-fold risk of adverse neonatal outcomes. Preeclamptic twin neonates had lower birth weights (β = −147.34, P = 0.005; β = −169.47, P = 0.001). The comparison on the discordance of intertwin weight was not significantly different.Twin pregnancies with PE are associated with worse perinatal outcomes. The adverse outcomes of preeclamptic twin pregnancies may be associated with lower birth weights rather than the discordance of the intertwin weight, which requires further confirmation. The results may provide helpful references for better clinical assessments, evaluations of prognosis, and a deeper understanding of preeclamptic twin pregnancies.

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Is gestational hypertension beneficial in twin pregnancies?

Cited by 9 publications

References 9 publications

Maternal hypertension and survival in singletons and twins born at 23–29 weeks: not just one answer…

Maternal hypertension and survival in singletons and twins born at 23–29 weeks: not just one answer…

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

Clinical characteristics of fetal and neonatal outcomes in twin pregnancy with preeclampsia in a retrospective case–control study

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