Effect of maternal chronic disease on obstetric complications in twin pregnancies in a United States cohort

Abstract

Objective To evaluate the effect of maternal chronic disease on obstetric complications among twin pregnancies. Design Multicenter retrospective observational study. Setting The 12 Consortium on Safe Labor (CSL) clinical centers (19 hospitals). Patient(s) Twin pregnancies (n=4,821) delivered ≥ 23 weeks of gestation and classified by maternal chronic disease (either none or any of the following: asthma, depression, hypertension, diabetes, and heart, thyroid, gastrointestinal or renal disease). Intervention(s) None. Main Outcome Measure(s) Gestational age at delivery, gestational hypertension, preeclampsia, gestational diabetes, placental abruption, placenta previa, hemorrhage, chorioamnionitis, maternal postpartum fever, premature rupture of membranes, labor onset (spontaneous versus nonspontaneous), route of delivery, and maternal admission to intensive care unit. Result(s) Women with chronic disease delivered earlier (mean gestational length, 34.1 vs. 34.6 weeks, p<0.0001) and were less likely to have term birth (risk ratio (RR): 0.80; 95% confidence interval (95% CI): 0.70-0.90). Cesarean delivery after spontaneous labor (RR: 1.20; 95% CI: 1.05-1.37) was also increased with chronic disease. No statistically significant effects were observed for other complications studied. Women who used ART were more likely to hemorrhage, independent of chronic disease, but other findings were generally similar to the non-ART sample. Conclusion(s) Chronic disease was associated with additional risk of earlier delivery and cesarean section after spontaneous labor in a nationwide sample of US twin pregnancies. Capsule Among twin pregnancies, maternal chronic disease was associated with additional risk of earlier delivery and cesarean section after spontaneous labor, but not with other obstetric complications.

Association of Prelabor Cesarean Delivery With Reduced Mortality in Twins Born Near Term

“…(21) However this study did not demonstrate any apparent increase in adverse birth outcomes associated with prelabor CD; indeed, the neonatal outcomes tended to favour prelabor CD.…”

Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health

“…Early preterm births are less frequent than late (34–36 weeks), as Vogel et al reported in the WHO Global Survey, with 11.9% of preterm birth below 34 completed weeks [ 6 ]. Higher early preterm rates are important, as they are associated with higher neonatal morbidity and perinatal death rates, mainly due to respiratory complications [ 6 , 23 , 25 , 26 ].…”

“…Perinatal death has been described as up to four times higher in twin pregnancies than in singletons, mainly due to preterm birth, fetal growth restriction, low Apgar scores and extremely low birth weight [ 5 , 6 , 23 , 25 ]. In our study, it was found to be 2.5 times higher for the first twin and 3.5 for the second one.…”

Perinatal outcomes of singleton siblings: the effects of changing maternal fertility status

“…The presence of chronic disease prior to pregnancy has been associated with an increased risk for hemorrhage in twin gestations [44]. The metabolic changes that occur during pregnancy, including relative hyperglycemia, hyperlipidemia, and disturbance of coagulation, represent a transient excursion into the metabolic syndrome [45].…”

“…ART national surveillance summaries are limited to birth outcomes reported by the patient herself or her obstetric provider [54][55][56]. Prior studies [44,45] have relied on linkages between ART cycles and vital records using only maternal and infant dates of birth or probabilistic algorithms [56]. Although there is a high degree of comparability between the SART CORS and vital records [27], our study design assures more accurate linkage between ART treatment cycles, vital records, and the hospital discharge birth data and a more complete picture of perinatal outcomes.…”