Outcomes Associated With Hypertensive Disorders of Pregnancy in Twin Compared With Singleton Gestations
Outcomes Associated With Hypertensive Disorders of Pregnancy in Twin Compared With Singleton Gestations
复制标题
DOI：
10.1097/aog.0000000000004506
复制
发表时间：
2021-09-01
影响因子：
7.2
通讯作者：
Melamed, Nir
中科院分区：
文献类型：
--
作者：
Aviram, Amir;Berger, Howard;Melamed, Nir
目的：评价双胎妊娠与妊娠高血压疾病相关的妊娠结局是否与单胎妊娠有相对差异。方法：我们对2012年至2019年在加拿大安大略省医院出生的所有活产单胎或双胞胎妇女进行了一项回顾性、基于人群的队列研究。数据来自安大略省更好的结果注册和网络。在双胎妊娠和单胎妊娠中分别比较有和无高血压妊娠障碍妇女的妊娠结局。校正相对危险度（aRRs）和95% ci采用改良泊松回归计算，并用相对危险度比较双胞胎和单胎。结果：总体而言，932,218名妇女符合研究标准，其中917,542名（98.4%）和14,676名（1.6%）分别为单胎和双胎妊娠。双胎妊娠期高血压疾病的发生率高于单胎妊娠（14.4% vs 6.4%, aRR 1.85[1.76-1.94]）。妊娠期高血压疾病仅与单胎妊娠的某些不良结局有关，与单胎妊娠和双胎妊娠的其他不良结局有关，但双胞胎的aRR较低。例如，妊娠37周前早产（单胎：15.2%[妊娠高血压疾病]vs 5.4%[无妊娠高血压疾病]，aRR 2.42；双胞胎：67.5%[妊娠高血压疾病]vs 50.4%[无妊娠高血压疾病]，aRR 1.30）和新生儿呼吸系统发病率(单胎：16.3%[妊娠高血压疾病]vs 8.7%[无妊娠高血压疾病]，aRR 1.50；双胞胎：39.8%[妊娠期高血压疾病]vs 32.7%[妊娠期无高血压疾病]，aRR 1.13)。这些发现在子痫前期和早发性子痫前期妇女亚组中持续存在。结论：尽管与单胎妊娠相比，双胎妊娠发生孕产妇和新生儿不良结局的绝对风险更高，但与高血压疾病相关的不良结局的增量风险低于单胎妊娠。这些发现可能部分归因于与单胎妊娠相比，双胎妊娠的早产基线风险和不良孕产妇及围产期结局较高。
OBJECTIVE: To evaluate whether pregnancy outcomes associated with hypertensive disorders of pregnancy in twin pregnancies differ relatively from those in singleton pregnancy. METHODS: We conducted a retrospective, population-based cohort study of all women with a liveborn singleton or twin hospital birth in Ontario, Canada, between 2012 and 2019. Data were obtained from the Better Outcomes Registry & Network Ontario. Pregnancy outcomes were compared between women with and without hypertensive disorders of pregnancy in twin gestations, and separately in singleton gestations. Adjusted relative risks (aRRs) and 95% CIs were generated using modified Poisson regression and were compared between twins and singletons using relative risk ratios. RESULTS: Overall, 932,218 women met the study criteria, of whom 917,542 (98.4%) and 14,676 (1.6%) had singleton and twin gestations, respectively. The incidence of hypertensive disorders of pregnancy was higher in women with twin compared with singleton gestations (14.4% vs 6.4%, aRR 1.85 [1.76-1.94]). Hypertensive disorders of pregnancy were associated with certain adverse outcomes in singleton gestations only and with other adverse outcomes in both the singleton and twin gestations, but the aRR was lower in twins. For example, preterm birth before 37 weeks of gestation (singletons: 15.2% [hypertensive disorders of pregnancy] vs 5.4% [no hypertensive disorders of pregnancy], aRR 2.42; twins: 67.5% [hypertensive disorders of pregnancy] vs 50.4% [no hypertensive disorders of pregnancy], aRR 1.30) and neonatal respiratory morbidity (singletons: 16.3% [hypertensive disorders of pregnancy] vs 8.7% [no hypertensive disorders of pregnancy], aRR 1.50; twins: 39.8% [hypertensive disorders of pregnancy] vs 32.7% [no hypertensive disorders of pregnancy], aRR 1.13). These findings persisted in the subgroups of women with preeclampsia and early-onset preeclampsia. CONCLUSIONS: Although the absolute risk of adverse maternal and neonatal outcomes is higher in twin compared with singleton pregnancies, the incremental risk of adverse outcomes associated with hypertensive disorders in twin pregnancies is lower than the incremental risk in singleton pregnancies. These findings may be attributed in part to the higher baseline risk of preterm birth and adverse maternal and perinatal outcomes in twin compared with singleton pregnancies.