Gestational hypertensive disease and birthweight discordance in twin pregnancies: a systematic review and meta-analysis

Wang, Yuan; Hongying, Zeng; Liu, Jing; Zhang, Feng

doi:10.1080/14767058.2021.2005572

Cited by 2 publications

(2 citation statements)

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“…Further basic and clinical research is required into the mechanism of intertwin BWD and preeclampsia. In recent years, several studies have focused on the association between growth discordance and gestational hypertensive disorders (GHD) (15,22). However, most of the studies set a single cut-off (20 or 25%) of BWD for the definition of growth discordance and were not consistent with each other (23,24).…”

Section: Discussionmentioning

confidence: 99%

“…As a common complication in twins, growth discordance is defined as intertwin birthweight difference (BWD) of 20% or more based on adverse neonatal outcomes (10)(11)(12)(13)(14). Recently, studies have shown that growth discordance is related to the risk of preeclampsia, where growth discordance was also defined as intertwin BWD of 20% or more (15). As intertwin BWD develops over a long period, however, no studies have illuminated the association between growth discordance as a continuous variable and the risk of preeclampsia.…”

Section: Introductionmentioning

confidence: 99%

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Optimal cutoffs of growth discordance for the risk of preeclampsia in twin pregnancies: A single-center retrospective cohort study

Zhu

An²,

Zhao³

et al. 2023

Front. Cardiovasc. Med.

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ObjectiveTo explore the optimal cutoffs of growth discordance for the risk of preeclampsia in twin pregnancies.MethodsA retrospective cohort study in a university hospital which included twins delivered from February 2013 to September 2020. Restrictive cubic spline (RCS) model was applied to the trend of intertwin birthweight difference (BWD) with the risk of preeclampsia. Logistic regression and subgroup analysis were performed to find the cut-off with statistical significance and clinical meaningfulness.ResultsA total of 2,631 women pregnant with twins were enrolled. RCS showed a nonlinear upward trend of preeclampsia with BWD, and the BWD of 15% was the initial rising point. With the confounders adjusted, only the group with BWD ≥ 25% was found to be significantly associated with an increased risk of preeclampsia (adjusted odds ratio [aOR], 2.44; 95% confidence interval [CI]: 1.74–3.42). Additionally, subgroup analysis showed that both monochorionic (MC) and small for gestational age (SGA) twins were more likely to complicate with preeclampsia.ConclusionThe growth discordance of 15% during pregnancy may be the preventive point of preeclampsia, and 25% may be the interventional point.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimal cutoffs of growth discordance for the risk of preeclampsia in twin pregnancies: A single-center retrospective cohort study

Zhu

An²,

Zhao³

et al. 2023

Front. Cardiovasc. Med.

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Relationships between birth weight discordance and maternal and perinatal risks among twin pregnancies conceived following frozen embryo transfer

et al. 2023

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STUDY QUESTION Is intertwin birth weight discordance associated with adverse maternal and perinatal outcomes following frozen embryo transfer (FET)? SUMMARY ANSWER For twins conceived following FET, intertwin birth weight discordance is related to elevated risks of neonatal mortality irrespective of chorionicity, and the risk of hypertensive disorders of pregnancy (HDP) is elevated for the mothers of dichorionic twins affected by such birth weight discordance. WHAT IS KNOWN ALREADY While the relationships between intertwin birth weight discordance and adverse maternal or fetal outcomes have been studied for naturally conceived twins, similarly comprehensive analyses for twins conceived using ART remain to be performed. STUDY DESIGN, SIZE, DURATION This was a retrospective cohort study of all twin births from 2007 to 2021 at Shanghai Ninth People’s Hospital in Shanghai, China that were conceived following FET (N = 6265). PARTICIPANTS/MATERIALS, SETTING, METHODS Intertwin birth weight discordance was defined as a 20% difference in neonatal birth weights. The primary study outcome was the incidence of HDP and neonatal death while secondary outcomes included gestational diabetes, placenta previa, placental abruption, intrahepatic cholestasis of pregnancy, preterm premature rupture of the membranes, Cesarean delivery, gestational age, birth weight, stillbirth, birth defect, neonatal jaundice, necrotizing enterocolitis, and pneumonia incidence. Logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% CIs for maternal and neonatal outcomes. Subgroup analyses were conducted, and Kaplan–Meier survival analysis was used to estimate the survival probability. The sensitivity analysis was performed with a propensity score-based patient-matching model, an inverse probability weighting model, a restricted cubic spline analysis, and logistic regression models using other percentage cutoffs for discordance. MAIN RESULTS AND THE ROLE OF CHANCE Of 6101 females that gave birth to dichorionic twins during the study interval, birth weight discordance was observed in 797 twin pairs (13.1%). In this cohort, intertwin birth weight discordance was related to an elevated risk of HDP (aOR 1.56; 95% CI 1.21–2.00), and this relationship was confirmed through sensitivity analyses. Hypertensive disease risk rose as the severity of this birth weight discordance increased. Discordant birth weight was also linked to increased odds of neonatal mortality (aOR 2.13; 95% CI 1.03–4.09) and this risk also increased with the severity of discordance. Of the 164 women with monochorionic twins, the discordant group exhibited an elevated risk of neonatal death compared to the concordant group (crude OR 9.00; 95% CI 1.02–79.3). LIMITATIONS, REASONS FOR CAUTION The limitations of this study are its retrospective nature and the fact that the available data could not specify which twins were affected by adverse outcomes. There is a lack of an established reference birth weight for Chinese twins born at a gestational age of 24–41 weeks. WIDER IMPLICATIONS OF THE FINDINGS These findings suggest that twins exhibiting a birth weight discordance are related to an elevated risk of adverse maternal and perinatal outcomes, emphasizing a potential need for higher levels of antenatal surveillance in these at-risk pregnancies. STUDY FUNDING/COMPETING INTEREST(S) Authors declare no conflict of interest. This study was funded by the Clinical Research Program of Shanghai Ninth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine (JYLJ202118) and the National Natural Science Foundation of China (Grant Nos 82271693 and 82273634). TRIAL REGISTRATION NUMBER N/A.

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Gestational hypertensive disease and birthweight discordance in twin pregnancies: a systematic review and meta-analysis

Cited by 2 publications

References 50 publications

Optimal cutoffs of growth discordance for the risk of preeclampsia in twin pregnancies: A single-center retrospective cohort study

Optimal cutoffs of growth discordance for the risk of preeclampsia in twin pregnancies: A single-center retrospective cohort study

Relationships between birth weight discordance and maternal and perinatal risks among twin pregnancies conceived following frozen embryo transfer

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