The association of hypertensive disorders of pregnancy with small for gestational age and intertwin birthweight discordance

Abstract

Available evidence shows conflicting results regarding the association between hypertensive disorders of pregnancy (HDPs)/preeclampsia (PE) and small for gestational age (SGA) and birthweight discordance (BWD). This retrospective study of 2131 twin pregnancies aimed to evaluate the association of HDPs/PE with the presence of SGA and BWD. The eligible pregnancies were categorized into four study groups: concordant pairs without SGA fetuses, discordant pairs without SGA fetuses, concordant pairs with SGA fetuses, and discordant pairs with SGA fetuses. We applied binary logistic regression models to compare the incidence of HDPs/PE and multinomial logit regression models to evaluate the severity of PE between the study groups. The models were adjusted for potential confounders. Increases in HDPs were observed in concordant (aOR, 2.33; 95% CI: 1.46–3.73) and discordant (aOR, 3.50; 95% CI: 2.26–5.43) pregnancies with SGA fetuses but not in discordant pregnancies without SGA fetuses (aOR, 1.42; 95% CI: 0.81–2.49); increases in PE were also found in concordant (aOR, 1.87; 95% CI: 1.08–3.23) and discordant (aOR, 3.75; 95% CI: 2.36–5.96) pregnancies with SGA fetuses but not in discordant pregnancies without SGA fetuses (aOR, 1.34; 95% CI: 0.71–2.52). Discordant pregnancies with SGA fetuses were associated with severe PE (aRRR, 3.48; 95% CI: 1.79–6.77), whereas concordant pregnancies with SGA fetuses were associated with only mild PE (aRRR, 2.54; 95% CI: 1.33–4.88). Our results suggest that SGA is associated with the development of HDP/PE, while discordant growth is associated with the severity of PE. These associations need to be further investigated using estimated fetal weight (EFW).

Pregnancy outcomes and risk factors for preeclampsia in dichorionic twin pregnancies after in vitro fertilization: a five-year retrospective study

“…On the other hand, growth discordance is associated with a high risk for preeclampsia in dichorionic twin pregnancy [ 15 , 34 ]. Sharing the same pathophysiologic mechanism may explain the interaction between preeclampsia and growth discordance.. Placental ischemia/hypoxia, which coexist either in preeclampsia or growth discordance women, appears to be responsible for this association [ 24 ].…”

The association between neonatal birthweight discordance and preeclampsia in twin pregnancy

“…Qiao et al 25 retrospectively analyzed 2122 women with twin pregnancies, drawing a conclusion that growth discordance is associated with a dose–response increased risk for PE in DC but not in MC twin pregnancy. Lin et al 26 studies have shown that SGA is associated with the development of HDP/PE, while discordant growth is associated with the severity of PE. Hiersch et al 14 included 1059 twin pregnancy women who was classified into one of four predetermined patterns based on the timing of onset and the progression of discordance: pattern 1, no significant discordance group (referent); pattern 2, early (<24 weeks' gestation) progressive discordance group; pattern 3, early discordance with plateau group; or pattern 4, late (≥24 weeks' gestation) discordance group, aiming to determine whether these patterns are predictive of adverse pregnancy outcomes, found that four distinct discordance growth patterns among twins that demonstrated a dose–response relationship with adverse outcomes include PTB and PE.…”

Gestational hypertensive disease and small for gestational age infants in twin pregnancy: A systematic review and meta‐analysis

“…The baseline information for all articles included in the review was shown in Table S2. Among all selected studies (one retrospective case-control study 31 and six retrospective cohort studies 22,23,[32][33][34][35] ), three were conducted in China, 31,34,35 two in the United States, 23,32 one in the UK, 33 and one in Italy. 22 All studies reported the incidence of SGA in twin pregnancies with hypertensive disorders and without.…”

“…And the prevalence of SGA in all included articles ranged from 6.3% to 43.6%. Three studies [33][34][35] conducted stratification by twin chorionicity, one of them 34 cannot extract the original data. In addition, there was only one study 23 reported the results of dichorionic twin pregnancies.…”

“…In addition, there was only one study 23 reported the results of dichorionic twin pregnancies. Six articles 22,23,[31][32][33]35 reported the results of the singleton birth weight reference for the diagnosis of SGA, and four articles 22,[33][34][35] reported the results of the diagnosis referred by twin birth weight.…”