Che Ronghua, Pei Jindan, Chen Huiyan, Dong Lingling, Wu Yuelin, Hua Xiaolin
Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Shanghai Tongji University School of Medicine, Shanghai, China.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):7146-7152. doi: 10.1080/14767058.2021.1945574. Epub 2021 Jun 27.
To investigate the influence of hypertensive disorders of pregnancy (HDP) on the perinatal outcomes in twin pregnancies.
This was a retrospective single-center study in which, 2160 twin pregnancies delivered between January 2016 and December 2019 were analyzed, 1661 of which were dichorionic (DC) and 499 monochorionic (MC). The perinatal outcomes were compared in 404 twin pregnancies with HDP, including 157 gestational hypertension (GH), 107 mild pre-eclampsia (MPE), 140 severe pre-eclampsia (SPE), and 1756 twins without hypertensive disorders of pregnancy (no-HDP). Multiple linear regression was performed to analyze the association between perinatal outcome and HDP. Stratified sampling by twin chorionicity (DC and MC) was also conducted.
There were 330 (19.9%) DC cases complicated with HDP and 74 (14.8%) MC with HDP, and the difference between the two groups was statistically significant (=.011). After stratification by chorionicity, in the DC twin, there were significantly more deliveries in the GH group, MPE group, and SPE group before 37 weeks than in the no-HDP group (=.000). Statistically significant differences were found among the four groups in the average small fetus birthweight, the intertwin weight difference, the relative weight discordance, the growth discordance, the incidence of very low birth weight (VLBW), low birth weight (LBW), and the Apgar scores of the small fetus (<.05). In MC twins, By comparison only on the average gestational age at delivery, the average small fetus birthweight, Apgar scores of large and small fetuses among the four groups, the difference was statistically significant (<.05). According to multiple linear regression analysis, after controlling for multiple confounding factors, it was found when the degree of HDP in DC twins increased by one grade, the small fetus birthweight decreased by an average of 19.044 g (=.007), the intertwin weight difference increased by an average of 14.311 g (=.034), the relative weight discordance increased by an average of 0.6% (=.013), and the gestational age at delivery decreased by an average of 0.160 weeks (=.001).
The perinatal outcomes of different chorionic twins with HDP are different. HDP has a greater impact on the perinatal outcomes of DC twins. The risk of adverse perinatal outcomes in DC twin pregnancy will increase accordingly with each increase in the grade of HDP, but HDP has little or no relevance on the perinatal outcomes of MC twins.
探讨妊娠高血压疾病（HDP）对双胎妊娠围产结局的影响。
这是一项回顾性单中心研究，分析了2016年1月至2019年12月期间分娩的2160例双胎妊娠，其中双绒毛膜（DC）双胎1661例，单绒毛膜（MC）双胎499例。比较了404例患有HDP的双胎妊娠的围产结局，包括157例妊娠期高血压（GH）、107例轻度子痫前期（MPE）、140例重度子痫前期（SPE），以及1756例未患妊娠高血压疾病（无HDP）的双胎。进行多元线性回归分析以探讨围产结局与HDP之间的关联。还按双胎绒毛膜性（DC和MC）进行了分层抽样。
有330例（19.9%）DC双胎合并HDP，74例（14.8%）MC双胎合并HDP，两组之间差异有统计学意义（P =.011）。按绒毛膜性分层后，在DC双胎中，GH组、MPE组和SPE组在37周前分娩的比例显著高于无HDP组（P =.000）。四组在平均小胎儿出生体重、双胎体重差异、相对体重不一致性、生长不一致性、极低出生体重（VLBW）发生率、低出生体重（LBW）发生率以及小胎儿的阿氏评分方面差异有统计学意义（P<.05）。在MC双胎中，仅比较四组间的平均分娩孕周、平均小胎儿出生体重、大胎儿和小胎儿的阿氏评分，差异有统计学意义（P<.05）。根据多元线性回归分析，在控制多个混杂因素后发现，DC双胎中HDP程度每增加一级，小胎儿出生体重平均降低19.044 g（P =.007），双胎体重差异平均增加14.311 g（P =.034），相对体重不一致性平均增加0.6%（P =.013），分娩孕周平均减少0.160周（P =.001）。
不同绒毛膜性的HDP双胎围产结局不同。HDP对DC双胎围产结局影响更大。DC双胎妊娠中，随着HDP程度每增加一级，不良围产结局风险相应增加，但HDP对MC双胎围产结局影响很小或无关联。
