Maternal clinical predictors of preterm birth in twin pregnancies: A systematic review involving 2,930,958 twin pregnancies

Marleen, Shemoon; Hettiarachchi, Janitha; Dandeniya, Ranmalie; Macgreggor, Rebecca; Aquilina, J.; Khalil, Asma; Vogel, Joshua P.; Betrán, Ana Pilar; Thangaratinam, Shakila

doi:10.1016/j.ejogrb.2018.09.025

Cited by 15 publications

(17 citation statements)

References 71 publications

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“…Our analysis also revealed that age <25 years was a risk factor for preterm birth before 34 and 32 weeks, which was consistent with earlier studies (59). Another study revealed that age <18 years seemed to be associated with preterm birth before 37 weeks (17). This indicated the importance of conception at an appropriate age.…”

Section: Discussionsupporting

confidence: 92%

“…The effect of PE, ICP, maternal age, and height on preterm birth among twin pregnancies have been discussed in published reports (13,17,34). These risk factors have also been identified in this study.…”

Section: Discussionsupporting

confidence: 56%

“…Methods for predicting preterm birth and risk factors for preterm birth in twin pregnancy have long been studied. A history of preterm birth (12), maternal clinical characteristics, such as age and height (13,14), gestational weight gain (GWG) (15,16), maternal complications, such as preeclampsia (17), biophysical and biochemical tests, (18) are all proposed to aid in identifying and optimizing management of preterm birth in twin gestation.…”

Section: Introductionmentioning

confidence: 99%

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Perinatal Outcomes and Risk Factors for Preterm Birth in Twin Pregnancies in a Chinese Population: A Multi-center Retrospective Study

Gao

Liu

et al. 2021

Front. Med.

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Background: Twin pregnancies are associated with an increased risk of adverse maternal and neonatal outcomes, mainly owing to prematurity. Few studies have evaluated the risk factors for preterm birth (PTB) in Chinese population. The objective of this study is to present the short-term maternal-neonatal outcomes, investigating the potential risk factors associated with preterm birth in Chinese twin pregnancies.Methods: A multi-center retrospective study of women pregnant with twins ≥28 weeks of gestation was conducted. Maternal and neonatal outcomes were analyzed. Logistic regression was used to identify potential risk factors for PTB before 37, 34, and 32 weeks, respectively.Results: A total of 3,288 twin pregnancies and 6,576 neonates were included in 99,585 pregnancies. The rate of twin pregnancy was 3.3%, while the PTB rate before 37, 34, and 32 weeks among this population were 62.1, 18.8, and 10.4%, respectively. Logistic regression revealed that monochorionicity [Odds ratio (OR) 3.028, 95% confident interval (CI) 2.489–3.683, P < 0.001], gestational weight gain (GWG) <10 kg (OR 2.285, 95% CI 1.563–3.339, P < 0.001) and GWG between 10 and 15 kg (OR 1.478, 95% CI 1.188–1.839, P < 0.001), preeclampsia (PE) (OR 3.067, 95% CI 2.142–4.390, P < 0.001), and intrahepatic cholestasis of pregnancy (ICP) (OR 3.122, 95% CI 2.121–4.596, P < 0.001) were the risk factors for PTB before 37 weeks. Monochorionicity (OR 2.865, 95% CI 2.344–3.501, P < 0.001), age < 25 years (OR 1.888, 95% CI 1.307–2.728, P = 0.001), and GWG <10 kg (OR 3.100, 95% CI 2.198–4.372, P < 0.001) were risk factors for PTB before 34 weeks. Monochorionicity (OR 2.566, 95% CI 1.991–3.307, P < 0.001), age younger than 25 years (OR 1.964, 95% CI 1.265–3.048, P = 0.003), and GWG <10 kg (OR 4.319, 95% CI 2.931–6.364, P < 0.001) were the risk factors for PTB before 32 weeks.Conclusions: Monochorionicity and GWG <10 kg were two major risk factors for PTB before 32, 34, and 37 weeks, whereas maternal age, PE, and ICP were also risk factors for PTB in specific gestational age.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

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Perinatal Outcomes and Risk Factors for Preterm Birth in Twin Pregnancies in a Chinese Population: A Multi-center Retrospective Study

Gao

Liu

et al. 2021

Front. Med.

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“…Both the low CS rate and high mortality might be partly the result of inadequate risk screening and referral during antenatal care, as proposed elsewhere. 47,48 In the context of revisions of antenatal care programmes in response to new WHO guidelines, 49 we believe that stronger attention to risk screening should be considered, which needs to include components to monitor the effect of such a policy change.…”

Section: Discussionmentioning

confidence: 99%

Trends in caesarean section rates between 2007 and 2013 in obstetric risk groups inspired by the Robson classification: results from population‐based surveys in a low‐resource setting

Hanson

Betrán

Opondo

et al. 2018

BJOG

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Objective To describe caesarean section rates and neonatal mortality to assess change in access to life‐saving interventions in a rural low‐resource setting between 2007 and 2013. Design Population‐based cross‐sectional study. Setting Southern Tanzania. Population A total of 34 063 women from 384 549 households who gave birth in the previous year. Methods Using data collected in two geo‐referenced household surveys conducted in 2007 and 2013 in the context of two cluster‐randomized controlled trials, we describe trends in caesarean section and neonatal mortality in obstetric risk groups inspired by the 10‐group Robson classification. Main outcome measures Rates of self‐reported birth by caesarean section and neonatal mortality. Results Population‐based caesarean section rates increased from 4.0% in 2007 to 6.4% in 2013. In 2013, the lowest caesarean section rate was found in multipara whose labour was not induced or augmented [4.4%, 95% confidence interval (CI) 3.9–4.9], a group that showed a rate increase of over 50% from 2007 [adjusted prevalence ratio 1.57 (95% CI 1.34–1.82)]. Nullipara whose labour was not induced or augmented had rates of 6.2% in 2007 and 8.5% in 2013. Caesarean rates in multiple pregnancies were low at 8.1% (95% CI 5.6–10.5) in 2007, and 14.6% (95% CI 9.4–19.8) in 2013. Overall neonatal mortality was high: 3.5% in 2007 and 3.2% in 2013, with rates being lowest in multiparous women whose labour was not induced or augmented: 2.4% (95% CI 2.2–2.7) and 1.7% (95% CI 1.4–2.0) in 2007 and 2013, respectively. Conclusion Although use of caesarean section remains insufficient, and higher rates do not necessarily imply better quality of care, our analysis highlights improvements in reaching women with caesarean section. Rates in multiple birth remained low compared with high‐income settings. Tweetable abstract In Southern Tanzania caesarean section rates increased over time, but the rate in high‐risk births remained alarmingly low.

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“…[4][5][6][7] Preterm birth is the most common perinatal morbidity associated with twin pregnancies, present in 30 to 50% of cases regardless of chorionicity. 8,9 Therefore, the current guidelines also recommend administration of antenatal corticosteroids to women with multiple pregnancy and threatened preterm delivery. However, it is uncertain whether the benefits of antenatal corticosteroids observed in singleton pregnancies are similar in twin pregnancies because of the small number of twin pregnancies included in the studies.…”

Section: Introductionmentioning

confidence: 99%

Enhanced elimination of betamethasone in dichorionic twin pregnancies

Rodrigues

Benzi²,

Matos

et al. 2021

Preprint

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Aims: No study has evaluated the BET pharmacokinetics in twin pregnancies separated by chorionicity. The aim this study is to describe and compare the BET pharmacokinetic parameters in singleton, dichorionic (DC) and monochorionic (MC) twin pregnancies in the third trimester of pregnancy. Methods: Twenty-six pregnant women received an intramuscular dose of 6 mg of BET sodium phosphate plus 6 mg BET acetate. Serial blood samples were collected for 24 hours after the first intramuscular BET esters dose. BET plasma concentrations were quantified using a validated HPLC analytical method. BET pharmacokinetic parameters were obtained employing a non-compartment model, and were compared using ANOVA’s test with Tukey’s multiple comparisons test. Correlations between clinical features and pharmacokinetic parameters were analyzed using Pearson’s correlation. Preliminary data on the BET placental transfer were also presented. Results: The geometric mean (IC 95%) of AUC0-∞ 670.0 (504.3-805.2) vs 434.9 (311.2-539.6) ng.h/mL and the CL/F 18.38 (13.84-22.65) vs 29.40 (21.17-36.69) were significantly lower and higher, respectively, in DC twin pregnancies compared to singleton. Others pharmacokinetic parameters did not differ among the groups. Conclusions: Data from this study suggest that the presence of two fetoplacental units may increase the BET metabolism by CYP3A4 enzyme and increase its elimination. Pharmacokinetic-pharmacodynamic clinical studies are needed to investigate whether this BET pharmacokinetic changes have clinical repercussions for the newborns and require dose adjustment in DC twin pregnancies.

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Maternal clinical predictors of preterm birth in twin pregnancies: A systematic review involving 2,930,958 twin pregnancies

Cited by 15 publications

References 71 publications

Perinatal Outcomes and Risk Factors for Preterm Birth in Twin Pregnancies in a Chinese Population: A Multi-center Retrospective Study

Perinatal Outcomes and Risk Factors for Preterm Birth in Twin Pregnancies in a Chinese Population: A Multi-center Retrospective Study

Trends in caesarean section rates between 2007 and 2013 in obstetric risk groups inspired by the Robson classification: results from population‐based surveys in a low‐resource setting

Enhanced elimination of betamethasone in dichorionic twin pregnancies

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