The impact of chorionicity on maternal pregnancy outcomes

Carter, Ebony B.; Bishop, Katherine; Goetzinger, Katherine; Tuuli, Methodius G.; Cahill, Alison G.

doi:10.1016/j.ajog.2015.05.027

Cited by 44 publications

(45 citation statements)

References 35 publications

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“…In 2013, massive proteinuria (ࣙ5 g) was eliminated from the diagnostic criteria of severe PE (ACOG; Task Force on Hypertension in Pregnancy, 2013). A recent study by Carter et al (2015) showed no differences in PE occurrence in MCP and DCP, which is opposite to our results. Their sample size was bigger (2,301 women); however, there were some differences between our study protocols, which may explain the inconsistency of the results: longer study period (Carter et al collected data from 1990(Carter et al collected data from to 2010, methods of data collection (Carter et al lost 10% of patients in the follow-up between the USG scan and perinatal period) and differences in ethnicity of both groups.…”

Section: Discussioncontrasting

confidence: 99%

Twin Chorionicity and the Risk of Hypertensive Disorders: Gestational Hypertension and Pre-eclampsia

et al. 2016

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Twin gestation is known to be a risk factor for hypertensive disorders of pregnancy. However, the relationship between hypertensive disorders (pre-eclampsia (PE) and gestational hypertension (GH)) and chorionicity of twin pregnancy is unclear, and published data is conflicting. We decided to analyze the relationship between placentation and prevalence of hypertensive disorders. It was a retrospective cohort study. 312 twin pregnancies delivered between 2009 and 2014 were analyzed, 79 of which were monochorionic and 233 dichorionic. The occurrence of PE and GH was established according to American College of Obstetricians and Gynecologists' (ACOG) guidelines. Hypertensive disorders were diagnosed significantly more often in dichorionic than in monochorionic twin pregnancies (19.7% vs. 8.9%; OR = 2.53 95% CI 1.04-6.45; p = .03). PE occurred more frequently in DCP (13.3% vs. 3.8%; OR = 3.88 95% CI 1.09-16.46; p = .02). There were no differences between those two groups in the prevalence of GH (6.4% vs. 5.1%; p = .79). The logistic regression model for the occurrence of PE included chorionicity, mother's age lower than 18 or higher than 40, pre-gestational obesity, in vitro fertilization, primiparity, gestational age at delivery, gestational diabetes, and active smoking. It showed that dichorionicity remained an independent risk factor for PE (adjusted OR = 4.97.0 95% CI 1.06-23.38; p = .04). Dichorionicity seems to be a risk factor for PE but not for GH development.

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Section: Discussioncontrasting

confidence: 99%

Twin Chorionicity and the Risk of Hypertensive Disorders: Gestational Hypertension and Pre-eclampsia

et al. 2016

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“…Our findings are in agreement with a previous study from Leduc et al 12. However, Carter and Lewi et al reported a comparable perinatal outcome between MCDA and DCDA twins with excluding specific complications for MCDA twins1820. This may be due to the difference in prenatal monitoring and interventions at these centers21.…”

Section: Discussionsupporting

confidence: 92%

Clinical outcomes after assisted reproductive technology in twin pregnancies: chorionicity-based comparison

Sun

Zou

Wei

et al. 2016

Sci Rep

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The chorionicity–based evaluation of the perinatal risk in twin pregnancies after assisted reproductive technology (ART) is lacking. A retrospective review was performed of all twin pregnancies monitored prenatally and delivered at our hospital between 2010 and 2014. Chorionicity was diagnosed by ultrasound examination at first trimester and confirmed by postnatal pathology. Pregnancy and perinatal outcomes were prospectively recorded. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated in a logistic regression model. A total of 1153 twin pregnancies were analyzed. The occurrence of preterm premature rupture of membranes (PPROM) was 3 times as frequent in monochorionic diamniotic (MCDA) twin pregnancies after ART as in those spontaneous counterparts (aOR 3.0; 95%CI 1.1–3.2). The prevalence of intrahepatic cholestasis of pregnancies (ICP) was significantly higher in dichorionic diamniotic (DCDA) twin pregnancies following ART compared to spontaneous DCDA pregnancies (aOR 3.3; 95%CI 1.3–5.6). Perinatal outcomes did not differ between two conception methods, either in MCDA or DCDA twin pregnancies. Based on differentiation of chorionicity, ART is associated with the increased risk of PPROM in MCDA twin pregnancies and with a higher rate of ICP in DCDA twin gestations. ART does not increase adversity of perinatal outcomes in twin pregnancies.

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“…The similarity among both reported study populations may explain the lack of difference when predicting the risk of stillbirth among SGA twins. The chorionicity of the twin was not known and therefore could not be accounted; although outcomes can vary based on this information, 37 this has also been problematic among other publications on topic. [8][9][10][11] We categorized newborns as SGA,…”

Section: Commentsmentioning

confidence: 99%