Rao Manasa G, Debolt Chelsea A, Wang Kelly, Khurana Sonia G, Mills Alexandra N, Paul Keisha, Vieira Luciana, Rebarber Andrei, Fox Nathan S, Stone Joanne
Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Center for Biostatistics, New York, New York.
Am J Perinatol. 2024 May;41(S 01):e2238-e2247. doi: 10.1055/a-2107-1755. Epub 2023 Jun 7.
Dichorionic twins have increased risk of preterm birth and hypertensive disorders of pregnancy. Grand multiparity may be associated with adverse perinatal outcomes in singleton pregnancies, although the effect of increasing parity in twins is unclear. This study aimed to elucidate whether grand multiparity leads to adverse outcomes in dichorionic twins compared with multiparity and nulliparity.
This was a retrospective review of dichorionic twins at a single institution between January 2008 and December 2019 comparing pregnancy outcomes among grand multiparity, multiparity, and nulliparity. Primary outcome was preterm birth less than 37 weeks. Multivariable regression controlled for differing demographics, prior preterm birth, use of reproductive technologies, and hypertensive disorders of pregnancy. Chi square and Fisher's exact were used for categorical variables and Kruskal-Wallis was used for continuous variables.
A total of 843 (60.3%) pregnancies were nulliparous, 499 (35.7%) multiparous, and 57(4.1%) grand multiparous. Univariate analysis indicated that multiparous women had lower incidence of preterm birth less than 37, 34, and 32 weeks (57 vs. 51%, = 0.04; 19.2 vs. 14.0%, = 0.02; 9.6 vs. 5.6%, = 0.01) and that grand multiparous women had lower incidence of preterm birth less than 34 weeks (19.2 vs. 5.3%, = 0.008) compared with nulliparous women. Multivariable regression confirmed multiparous women had lower odds of preterm birth less than 34 and 32 weeks compared with nulliparous women (<34 wk: odds ratio [OR] = 0.69, 95% confidence interval [CI] = 0.49-0.97, = 0.03; <32 wk: OR = 0.48, 95% CI = 0.29-0.79, = 0.004) and that multiparous women (OR = 0.57, 95% CI = 0.42-0.77, = 0.0002) and grand multiparous women (OR = 0.23, 95% CI = 0.08-0.68, = 0.0074) had lower incidence of hypertensive disorders of pregnancy when compared with nulliparous women.
Grand multiparity is not associated with adverse perinatal outcomes compared with nulliparity or multiparity in dichorionic twins. Increasing parity may protect against incidence of preterm birth and hypertensive disorders of pregnancy even among grand multiparous women.
· Incidence of preterm birth may decrease with increasing parity in twins.. · Hypertensive disorders of pregnancy may decrease with increasing parity in twins.. · Grand multiparity is not associated with adverse perinatal outcomes in twins..
双绒毛膜双胎早产和妊娠期高血压疾病的风险增加。多产可能与单胎妊娠的不良围产期结局有关，尽管双胎妊娠中随着产次增加的影响尚不清楚。本研究旨在阐明与经产妇和初产妇相比，多产是否会导致双绒毛膜双胎出现不良结局。
这是一项对2008年1月至2019年12月期间在单一机构的双绒毛膜双胎进行的回顾性研究，比较了多产、经产和初产的妊娠结局。主要结局是孕周小于37周的早产。多变量回归控制了不同的人口统计学特征、既往早产史、生殖技术的使用以及妊娠期高血压疾病。卡方检验和费舍尔精确检验用于分类变量，克鲁斯卡尔-沃利斯检验用于连续变量。
共有843例（60.3%）妊娠为初产，499例（35.7%）为经产，57例（4.1%）为多产。单因素分析表明，经产妇孕周小于37、34和32周的早产发生率较低（57%对51%，P = 0.04；19.2%对14.0%，P = 0.02；9.6%对5.6%，P = 0.01），与初产妇相比，多产妇孕周小于34周的早产发生率较低（19.2%对5.3%，P = 0.008）。多变量回归证实，与初产妇相比，经产妇孕周小于34和32周的早产几率较低（<34周：比值比[OR]=0.69，95%置信区间[CI]=0.49 - 0.97，P = 0.03；<32周：OR = 0.48，95% CI = 0.29 - 0.79，P = 0.004），与初产妇相比，经产妇（OR = 0.57，95% CI = 0.42 - 0.77，P = 0.0002）和多产妇（OR = 0.23，95% CI = 0.08 - 0.68，P = 0.0074）妊娠期高血压疾病的发生率较低。
与双绒毛膜双胎的初产或经产相比，多产与不良围产期结局无关。即使在多产妇中，产次增加也可能预防早产和妊娠期高血压疾病的发生。
·双胎早产发生率可能随产次增加而降低。·双胎妊娠期高血压疾病可能随产次增加而降低。·多产与双胎不良围产期结局无关。
