Risk Factors for Preeclampsia in Twin Pregnancies

Abstract

Objective Twin pregnancy is associated with an increased incidence of preeclampsia. However, it is unknown if the risk factors for preeclampsia in twin pregnancies are the same as those in singleton pregnancies.

Methods Case–control analysis of all twin pregnancies managed by one maternal-fetal medicine practice from 2005 to 2012. Patients with chronic hypertension were excluded, as were monochorionic-monoamniotic twins. We compared patient and pregnancy characteristics between patients who did and did not develop preeclampsia, according to standard American College of Obstetricians and Gynecologists definitions. Odds ratios, adjusted odds ratios (aORs), and 95% confidence intervals (CIs) were obtained using chi-square analysis and logistic regression.

Results Of the patients with twin pregnancies, 513 were included, and 76 (14.8%) patients developed preeclampsia. On univariable analysis, the risk factors associated with preeclampsia in twin pregnancies were egg donation, nonwhite race, nulliparity, prepregnancy obesity, and gestational diabetes. On adjusted analysis, the risk factors independently associated with preeclampsia were egg donation (aOR 2.409, 95% CI 1.051, 5.524) and prepregnancy obesity (aOR 2.367, 95% CI 1.079, 5.192).

Conclusions In twin pregnancy, the risk factors independently associated with preeclampsia are egg donation and prepregnancy obesity.

Keywords

twin - preeclampsia - risk factors - hypertension

• References

• 1 Martin JA, Hamilton BE, Osterman MJK. Three Decades of Twin Births in the United States, 1980–2009. NCHS data brief, no. 80. Hyattsville, MD: National Center for Health Statistics; 2012
• 2 American College of Obstetricians and Gynecologists. Multiple Gestation: Complicated Twin, Triplet, and High-Order Multifetal Pregnancy. ACOG Practice Bulletin 56. Washington, DC: ACOG; 2004
• 3 Sibai BM, Hauth J, Caritis S , et al; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Hypertensive disorders in twin versus singleton gestations. Am J Obstet Gynecol 2000; 182: 938-942
• 4 Krotz S, Fajardo J, Ghandi S, Patel A, Keith LG. Hypertensive disease in twin pregnancies: a review. Twin Res 2002; 5: 8-14
• 5 Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ 2005; 330: 565
• 6 Reddy UM, Wapner RJ, Rebar RW, Tasca RJ. Infertility, assisted reproductive technology, and adverse pregnancy outcomes: executive summary of a National Institute of Child Health and Human Development workshop. Obstet Gynecol 2007; 109: 967-977
• 7 Robinson HE, O'Connell CM, Joseph KS, McLeod NL. Maternal outcomes in pregnancies complicated by obesity. Obstet Gynecol 2005; 106: 1357-1364
• 8 Coonrod DV, Hickok DE, Zhu K, Easterling TR, Daling JR. Risk factors for preeclampsia in twin pregnancies: a population-based cohort study. Obstet Gynecol 1995; 85 (5 Pt 1) 645-650
• 9 Erez O, Vardi IS, Hallak M, Hershkovitz R, Dukler D, Mazor M. Preeclampsia in twin gestations: association with IVF treatments, parity and maternal age. J Matern Fetal Neonatal Med 2006; 19: 141-146
• 10 Suzuki S, Igarashi M. Risk factors for preeclampsia in Japanese twin pregnancies: comparison with those in singleton pregnancies. Arch Gynecol Obstet 2009; 280: 389-393
• 11 Lučovnik M, Tul N, Verdenik I, Novak Z, Blickstein I. Risk factors for preeclampsia in twin pregnancies: a population-based matched case-control study. J Perinat Med 2012; 40: 379-382
• 12 American College of Obstetricians and Gynecologists. Diagnosis and Management of Preeclampsia. ACOG Practice Bulletin 33. Washington, DC: ACOG; 2002
• 13 Fox NS, Rebarber A, Klauser CK, Roman AS, Saltzman DH. Intrauterine growth restriction in twin pregnancies: incidence and associated risk factors. Am J Perinatol 2011; 28: 267-272
• 14 Fox NS, Rebarber A, Dunham SM, Saltzman DH. Outcomes of multiple gestations with advanced maternal age. J Matern Fetal Neonatal Med 2009; 22: 593-596
• 15 O'Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology 2003; 14: 368-374
• 16 Wiggins DA, Main E. Outcomes of pregnancies achieved by donor egg in vitro fertilization—a comparison with standard in vitro fertilization pregnancies. Am J Obstet Gynecol 2005; 192: 2002-2006 , discussion 2006–2008
• 17 Keegan DA, Krey LC, Chang HC, Noyes N. Increased risk of pregnancy-induced hypertension in young recipients of donated oocytes. Fertil Steril 2007; 87: 776-781
• 18 Klatsky PC, Delaney SS, Caughey AB, Tran ND, Schattman GL, Rosenwaks Z. The role of embryonic origin in preeclampsia: a comparison of autologous in vitro fertilization and ovum donor pregnancies. Obstet Gynecol 2010; 116: 1387-1392