Department of Obstetrics and Gynecology, Reproduction and Development Research Institute, Amsterdam UMC, VU Medical Center, Amsterdam, The Netherlands.
Department of Obstetrics and Gynecology, ETZ Hospital, Tilburg, The Netherlands.
Hypertens Pregnancy. 2023 Dec;42(1):2225597. doi: 10.1080/10641955.2023.2225597.
To systematically review the literature on hypertensive disorders of pregnancy (HDP) after multifetal pregnancy reduction (MFPR).
A comprehensive search in PubMed, Embase, Web of Science, and Scopus was performed. Prospective or retrospective studies reporting on MFPR from triplet or higher-order to twin compared to ongoing (i.e., non-reduced) triplets and/or twins were included. A meta-analysis of the primary outcome HDP was carried out using a random-effects model. Subgroup analyses of gestational hypertension (GH) and preeclampsia (PE) were performed. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale.
Thirty studies with a total of 9,811 women were included. MFPR from triplet to twin was associated with a lower risk for HDP compared to ongoing triplets (OR 0.55, 95% CI, 0.37-0.83; = 0.004). In a subgroup analysis, the decreased risk of HDP was driven by GH, and PE was no longer significant (OR 0.34, 95% CI, 0.17-0.70; = 0.004 and OR 0.64, 95% CI, 0.38-1.09; = 0.10, respectively). HDP was also significantly lower after MFPR from all higher-order (including triplets) to twin compared to ongoing triplets (OR 0.55, 95% CI, 0.38-0.79; = 0.001). In a subgroup analysis, the decreased risk of HDP was driven by PE, and GH was no longer significant (OR 0.55, 95% CI 0.32-0.92; = 0.02 and OR 0.55, 95% CI 0.28-1.06; = 0.08, respectively). No significant differences in HDP were found in MFPR from triplet or higher-order to twin versus ongoing twins.
MFPR in women with triplet and higher-order multifetal pregnancies decreases the risk of HDP. Twelve women should undergo MFPR to prevent one event of HDP. These data can be used in the decision-making process of MFPR, in which the individual risk factors of HDP can be taken into account.
系统综述多胎妊娠减少（MFPR）后妊娠高血压疾病（HDP）的文献。
在 PubMed、Embase、Web of Science 和 Scopus 中进行全面检索。纳入了比较 MFPR 从三胞胎或更高多胎到双胞胎与继续（即未减少）三胞胎和/或双胞胎的前瞻性或回顾性研究。使用随机效应模型对主要结局 HDP 进行荟萃分析。进行了妊娠高血压（GH）和子痫前期（PE）的亚组分析。使用纽卡斯尔-渥太华质量评估量表评估偏倚风险。
纳入了 30 项研究，共 9811 名女性。与继续三胞胎相比，三胞胎或更高多胎减少到双胞胎与 HDP 的风险较低（OR 0.55，95%CI，0.37-0.83；=0.004）。在亚组分析中，HDP 风险降低是由 GH 驱动的，而 PE 不再显著（OR 0.34，95%CI，0.17-0.70；=0.004 和 OR 0.64，95%CI，0.38-1.09；=0.10）。与继续三胞胎相比，所有多胎（包括三胞胎）减少到双胞胎与 HDP 的风险也显著降低（OR 0.55，95%CI，0.38-0.79；=0.001）。在亚组分析中，HDP 风险降低是由 PE 驱动的，而 GH 不再显著（OR 0.55，95%CI 0.32-0.92；=0.02 和 OR 0.55，95%CI 0.28-1.06；=0.08）。MFPR 从三胞胎或更高多胎到双胞胎与继续双胞胎相比，HDP 无显著差异。应进行 12 例 MFPR 以预防 1 例 HDP 事件。这些数据可用于 MFPR 的决策过程中，可考虑 HDP 的个体危险因素。
