Ping Qiao1, Yan Zhao2, Xiang Jiang1, Chuanlu Xu1, Yingying Yang2, Yirong Bao1, Han Xie3, Hao Ying4. 1. Departments of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, PR China. 2. Department of Women & Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, PR China. 3. Departments of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, PR China. Electronic address: hemoglobin@163.com. 4. Departments of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, PR China. Electronic address: stephenying_2011@163.com.
Abstract
BACKGROUND: Despite extensive investigations over the last decade, preeclampsia (PE) remains an unpredictable pregnancy complication causing perinatal morbidity and mortality worldwide, particularly in twin pregnancies. OBJECTIVE: This study aimed to determine the relationship between growth discordance in twin pregnancies and the risk for PE, based on chorionicity. STUDY DESIGN: This was a retrospective single-center study in which 2122 women with twin pregnancies who were admitted to a tertiary hospital between January 2013 and June 2016 were included. Growth discordance was defined as a twin birth weight difference ≥20%. Logistic regression models were used to analyze the associations between twin growth discordance and gestational hypertension-PE (GH-PE) risk. In addition to logistic regression analyses of all subjects, stratified modeling by twin chorionicity (dichorionic (DC) and monochorionic (MC)) was conducted. Further analysis was performed to estimate the associations between growth discordance degree and GH-PE risk in MC and DC twin pregnancies. RESULTS: The prevalence of growth discordance was 17.6%. In all subjects, twin growth discordance was associated with increased risk of GH-PE risk. After stratified by twin chorionicity, growth discordance was associated with an increased risk for GH-PE (AOR=1.84; 95% CI, 1.26-2.67) and PE (AOR=1.82; 95% CI:1.21-2.73;), including mild PE (AOR=1.86; 95% CI: 1.02-3.37), severe PE (AOR=1.78; 95% CI: 1.06-2.97; P<0.05), and early-onset PE (AOR=2.98; 95% CI: 1.40-6.32) among DC twin pregnancy group; however, no significant association was found among MC twin pregnancy group. A 10% increment of growth discordance in DC twin pregnancy group was associated with an elevated risk for GH-PE (AOR=1.20; 95% CI: 1.02-1.41;) and PE (AOR=1.24; 95% CI: 1.04-1.48), including severe PE (AOR=1.28; 95% CI: 1.04-1.59), early-onset PE (AOR=1.47; 95% CI: 1.08-2.00), and no significant association was found among MC twin pregnancy. CONCLUSIONS: Growth discordance is associated with a high risk for PE in DC but not MC twin pregnancy. Additionally, the prevalence of PE increases significantly with increasing degree of discordant growth, reflecting a dose-response relationship in DC twin pregnancy.
BACKGROUND: Despite extensive investigations over the last decade, preeclampsia (PE) remains an unpredictable pregnancy complication causing perinatal morbidity and mortality worldwide, particularly in twin pregnancies. OBJECTIVE: This study aimed to determine the relationship between growth discordance in twin pregnancies and the risk for PE, based on chorionicity. STUDY DESIGN: This was a retrospective single-center study in which 2122 women with twin pregnancies who were admitted to a tertiary hospital between January 2013 and June 2016 were included. Growth discordance was defined as a twin birth weight difference ≥20%. Logistic regression models were used to analyze the associations between twin growth discordance and gestational hypertension-PE (GH-PE) risk. In addition to logistic regression analyses of all subjects, stratified modeling by twin chorionicity (dichorionic (DC) and monochorionic (MC)) was conducted. Further analysis was performed to estimate the associations between growth discordance degree and GH-PE risk in MC and DC twin pregnancies. RESULTS: The prevalence of growth discordance was 17.6%. In all subjects, twin growth discordance was associated with increased risk of GH-PE risk. After stratified by twin chorionicity, growth discordance was associated with an increased risk for GH-PE (AOR=1.84; 95% CI, 1.26-2.67) and PE (AOR=1.82; 95% CI:1.21-2.73;), including mild PE (AOR=1.86; 95% CI: 1.02-3.37), severe PE (AOR=1.78; 95% CI: 1.06-2.97; P<0.05), and early-onset PE (AOR=2.98; 95% CI: 1.40-6.32) among DC twin pregnancy group; however, no significant association was found among MC twin pregnancy group. A 10% increment of growth discordance in DC twin pregnancy group was associated with an elevated risk for GH-PE (AOR=1.20; 95% CI: 1.02-1.41;) and PE (AOR=1.24; 95% CI: 1.04-1.48), including severe PE (AOR=1.28; 95% CI: 1.04-1.59), early-onset PE (AOR=1.47; 95% CI: 1.08-2.00), and no significant association was found among MC twin pregnancy. CONCLUSIONS: Growth discordance is associated with a high risk for PE in DC but not MC twin pregnancy. Additionally, the prevalence of PE increases significantly with increasing degree of discordant growth, reflecting a dose-response relationship in DC twin pregnancy.
Authors: Xiao Song Liu; Xiu Juan Su; Guo Hua Li; Shi Jia Huang; Yang Liu; Han Xiang Sun; Qiao Ling Du Journal: Endocrinology Date: 2022-08-01 Impact factor: 5.051