Lin Ruby, Fields Jessica C, Lee Rachel, Rosenfeld Emily B, Daggett Emily E, Sharma Ruchira, Ananth Cande V
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Department of Obstetrics and Gynecology, ChristianaCare, Newark, DE, USA.
Eur Heart J. 2025 Apr 1;46(13):1219-1228. doi: 10.1093/eurheartj/ehaf003.
Increased cardiovascular demand in twin pregnancies, even those without hypertensive disease of pregnancy (HDP), may pose a greater risk for cardiovascular complications compared with singletons. In this study, the risk of cardiovascular disease (CVD)-related hospitalizations and mortality within the year following delivery in relation to HDP was compared between twin and singleton pregnancies.
Using the Nationwide Readmissions Database of US hospitals from 2010 to 2020, the rates of CVD readmission in four exposure groups (twin deliveries with and without HDP and singleton deliveries with and without HDP) were estimated. Cox proportional hazard regression models were used to determine associations with singletons without HDP as the reference.
Of 36 million delivery hospitalizations, the rates of CVD readmission in twin and singleton pregnancies were 1105.4 and 734.1 per 100 000 delivery admissions, respectively. Compared with singletons without HDP, the adjusted hazard ratio (HR) of CVD readmission was highest for twins with HDP [HR 8.21, 95% confidence interval (CI) 7.48-9.01], followed by singletons with HDP (HR 5.89, 95% CI 5.70-6.08) and then twins without HDP (HR 1.95, 95% CI 1.75, 2.17).
Compared with singletons without HDP, twin pregnancies, even in the absence of HDP, are associated with increased risks for CVD complications in the first year post-partum. These findings highlight the increased strain twin pregnancies place on the maternal cardiovascular system. These findings advocate the need for appropriate pre-conception counselling for those with cardiovascular risk factors undergoing infertility treatment, which increase the risks of multi-foetal gestation, and increased post-partum surveillance in twin pregnancies.
双胎妊娠时心血管需求增加，即使是那些没有妊娠高血压疾病（HDP）的双胎妊娠，与单胎妊娠相比，可能面临更大的心血管并发症风险。在本研究中，比较了双胎妊娠和单胎妊娠产后一年内与HDP相关的心血管疾病（CVD）住院和死亡风险。
利用2010年至2020年美国医院全国再入院数据库，估计了四个暴露组（有和没有HDP的双胎分娩以及有和没有HDP的单胎分娩）的CVD再入院率。以没有HDP的单胎妊娠作为对照，采用Cox比例风险回归模型来确定相关性。
在3600万例分娩住院病例中，双胎妊娠和单胎妊娠的CVD再入院率分别为每10万例分娩入院1105.4例和734.1例。与没有HDP的单胎妊娠相比，有HDP的双胎妊娠CVD再入院的调整后风险比（HR）最高[HR 8.21，95%置信区间（CI）7.48 - 9.01]，其次是有HDP的单胎妊娠（HR 5.89，95%CI 5.70 - 6.08），然后是没有HDP的双胎妊娠（HR 1.95，95%CI 1.75，2.17）。
与没有HDP的单胎妊娠相比，双胎妊娠即使没有HDP，在产后第一年发生CVD并发症的风险也会增加。这些发现凸显了双胎妊娠对母体心血管系统造成的压力增加。这些发现提倡对于那些有心血管危险因素且正在接受不孕治疗（这会增加多胎妊娠风险）的人群，需要进行适当的孕前咨询，并加强双胎妊娠的产后监测。
