Recurrence risk of preeclampsia in twin and singleton pregnancies

Trogstad, Lill; Skrondal, Anders; Stoltenberg, Camilla; Magnus, Per; Nesheim, Britt‐Ingjerd; Eskild, Anne

doi:10.1002/ajmg.a.20512

Cited by 68 publications

(49 citation statements)

References 37 publications

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“…These findings are in agreement with other previously published studies [9,16] suggesting that PE in singletons is more likely to be superimposed on a chronic hypertensive state and is more likely to re-occur in future pregnancies, as described by Trogstad et al [18].…”

Section: Discussionsupporting

confidence: 83%

“…The differentiation between PE in singletons versus twins in terms of maternal risk factors [8][9][10], pathogenesis [11][12][13][14], clinical manifestations [2,10,[15][16][17], and pregnancy outcome [2,10,15,16,18] have been investigated. Some of these studies are contradictive in their results, yet it seems that in many aspects, PE in twins significantly differs from PE in singletons.…”

Section: Introductionmentioning

confidence: 99%

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Placental Component and Pregnancy Outcome in Singleton versus Twin Pregnancies Complicated by Preeclampsia

Weiner¹,

Feldstein²,

Schreiber

et al. 2017

Fetal Diagn Ther

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Objective: To compare placental histopathological lesions and pregnancy outcomes in singleton and twin pregnancies complicated by preeclampsia (PE). Methods: Maternal characteristics, neonatal outcomes, and placental histopathology reports of pregnancies complicated by PE between January 2008 and October 2016 were reviewed. Results were compared between singletons (singleton group) and dichorionic-diamniotic twins (twin group). Placental lesions were classified into maternal and fetal vascular supply lesions. Small for gestational age (SGA) was defined as birth weight ≤10th percentile. Composite adverse neonatal outcome was defined as one or more early neonatal complications. Results: Compared to the twin group (n = 67), the singleton group (n = 275) was characterized by lower maternal age (p = 0.003), higher gestational age (p < 0.001), higher rates of previous PE (p = 0.017), chronic hypertension (p = 0.036), and severe features (p < 0.001). Placentas from the singleton group were characterized by higher rates of maternal vascular malperfusion lesions (p < 0.001) and fetal vascular supply lesions (p = 0.002). Using multivariable regression analysis, composite maternal and fetal vascular malperfusion lesions were independently associated with singletons (aOR = 2.7, 95% CI = 1.2-7.8, p < 0.001, and aOR = 1.2, 95% CI = 1.2-5.6, p = 0.025, respectively). SGA was more common in the singleton group (p = 0.002). Neonatal outcome did not differ between the groups. Conclusion: Placentas from singleton pregnancies complicated by PE were characterized by higher rates of maternal and fetal vascular lesions compared to those from twin pregnancies, suggesting that different mechanisms participate in the development of PE in these two groups.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Placental Component and Pregnancy Outcome in Singleton versus Twin Pregnancies Complicated by Preeclampsia

Weiner¹,

Feldstein²,

Schreiber

et al. 2017

Fetal Diagn Ther

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“…However, these results should be interpreted with caution, as the effects of L-arginine alone were not studied. Furthermore, the study population reported an exceptionally high recurrence rate of pre-eclampsia (30 %), compared with approximately up to 5-16 % recurrence risk observed in other countries [130][131][132][133]; therefore, results may not be generalizable or applicable to other obstetric populations. Of note, a small study of intravenous infusion of L-arginine in pregnant women showed a significant reduction in blood pressure, and this effect was more pronounced in those with pre-eclampsia [134].…”

Section: Potential Novel Therapiesmentioning

confidence: 99%

Hypertension in Pregnancy: Natural History and Treatment Options

et al. 2015

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Hypertensive disorders of pregnancy affect approximately 5-10% of all maternities and are major contributors of maternal and neonatal morbidity and mortality worldwide. This group of disorders encompasses chronic hypertension, as well as conditions that arise de novo in pregnancy: gestational hypertension and pre-eclampsia. The latter group is thought to be part of the same continuum but with arbitrary division. Research into the aetiology of hypertension in pregnancy have largely been focused on pre-eclampsia, with a majority of studies exploring either pregnancy-associated factors such as placental-derived or immunologic responses to pregnancy tissue, or maternal constitutional factors such as cardiovascular health and endothelial dysfunction. The evidence base for the pathophysiology and progression of hypertensive disorders in pregnancy, particularly pre-eclampsia, is reviewed. Clinical algorithms and pharmacological agents for the management of hypertension in pregnancy are summarised, with a brief focus on post-partum considerations and long-term health implications. Novel therapeutic options for the management of pre-eclampsia are also explored.

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“…Most of the women were included from 3 registry-based studies that lack demographic and clinical detail. 31,32,38 Two authors of included registry-based studies were unable to provide the original data but offered to perform a new data-extraction. 22,38 They used the criteria from the initial study to create an extended and more recent database.…”

Section: Study Selectionmentioning

confidence: 99%