Clinical risk factors for preeclampsia in twin pregnancies

Comparison of perinatal outcome and mode of birth of twin and singleton pregnancies in migrant and refugee populations on the Thai Myanmar border: A population cohort

BACKGROUND

In low- and middle-income countries twin births have a high risk of complications partly due to barriers to accessing hospital care. This study compares pregnancy outcomes, maternal and neonatal morbidity and mortality of twin to singleton pregnancy in refugee and migrant clinics on the Thai Myanmar border.

METHODS

A retrospective review of medical records of all singleton and twin pregnancies delivered or followed at antenatal clinics of the Shoklo Malaria Research Unit from 1986 to 2020, with a known outcome and estimated gestational age. Logistic regression was done to compare the odds of maternal and neonatal outcomes between twin and singleton pregnancies.

RESULTS

Between 1986 and 2020 this unstable and migratory population had a recorded outcome of pregnancy of 28 weeks or more for 597 twin births and 59,005 singleton births. Twinning rate was low and stable (<9 per 1,000) over 30 years. Three-quarters (446/597) of the twin pregnancies and 96% (56,626/59,005) of singletons birthed vaginally. During pregnancy, a significantly higher proportion of twin pregnancies compared to singleton had pre-eclampsia (7.0% versus 1.7%), gestational hypertension (9.9% versus 3.9%) and eclampsia (1.0% versus 0.2%). The stillbirth rate of twin 1 and twin 2 was higher compared to singletons: twin 1 25 per 1,000 (15/595), twin 2 64 per 1,000 (38/595) and singletons 12 per 1,000 (680/58,781). The estimated odds ratio (95% confidence interval (CI)) for stillbirth of twin 1 and twin 2 compared to singletons was 2.2 (95% CI 1.3-3.6) and 5.8 (95% CI 4.1-8.1); and maternal death 2.0 (0.95-11.4), respectively, As expected most perinatal deaths were 28 to <32 week gestation.

CONCLUSION

In this fragile setting where access to hospital care is difficult, three in four twins birthed vaginally. Twin pregnancies have a higher maternal morbidity and perinatal mortality, especially the second twin, compared to singleton pregnancies.

Predictive value of the soluble fms-like tyrosine kinase 1 to placental growth factor ratio for preeclampsia in twin pregnancies: a systematic review and meta-analysis

OBJECTIVE

In recent years, the ratio of soluble fms-like tyrosine kinase 1 to placental growth factor for use in predicting preeclampsia has been explored extensively. Despite extensive research, available data on its effectiveness in predicting preeclampsia in twin pregnancies are limited and conflicting. This meta-analysis aimed to assess the diagnostic accuracy of the soluble fms-like tyrosine kinase 1 to placental growth factor ratio in distinguishing cases with preeclampsia in twin pregnancies from healthy controls.

DATA SOURCES

Studies that evaluated the use of the soluble fms-like tyrosine kinase 1 to placental growth factor ratio in predicting preeclampsia were searched in PubMed, Embase, and Cochrane databases from inception to August 6, 2023, without language restriction.

STUDY ELIGIBILITY CRITERIA

The following population, exposure, comparators, outcomes, and study designs were included: women with twin pregnancies; an increased soluble fms-like tyrosine kinase 1 to placental growth factor ratio with preeclampsia as the outcome; women without preeclampsia; a 2 × 2 diagnostic table, diagnostic accuracy data, and the incidence of preeclampsia; and prospective cohort studies and observational comparative studies, respectively.

STUDY APPRAISAL AND SYNTHESIS METHODS

The quality of the included studies was evaluated. Key parameters, including the specificity, sensitivity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio, were calculated using the random- and fixed-effects models. In addition, the area under the receiver operating characteristic curve and the summary receiver operating characteristic curve were evaluated.

RESULTS

A total of 7 studies were included, including 442 women with twin pregnancies (115 patients with preeclampsia and 327 controls without preeclampsia). The results highlighted the promising effectiveness of the soluble fms-like tyrosine kinase 1 to placental growth factor ratio in predicting preeclampsia in twin pregnancies with a pooled specificity of 0.89 (95% confidence interval, 0.80-0.95), a sensitivity of 0.84 (95% confidence interval, 0.73-0.93), a positive likelihood ratio of 32.76 (95% confidence interval, 12.82-83.74), and a negative likelihood ratio of 0.03 (95% confidence interval, 0.01-0.08). The combined diagnostic odds ratio was 35.72 (95% confidence interval, 12.92-98.76), and the area under the receiver operating characteristic curve was 0.92.

CONCLUSION

These collective findings underscore the potential of the soluble fms-like tyrosine kinase 1 to placental growth factor ratio as an accurate marker for identifying preeclampsia among women with twin pregnancies.

Preeclampsia and its determinants in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Preeclampsia is a serious condition that is linked to poor perinatal outcomes. In Ethiopia, the overall prevalence of preeclampsia and its associated factors is uncertain. Therefore, the purpose of this review was to find the prevalence of pre-eclampsia and its determinants in Ethiopia.

METHODS

To find primary studies, PubMed, Google Scholar, HINAR, Scopus, the Web of Sciences, and grey literature searches were used between January 1, 2013, and January 1, 2023, in Ethiopia. A Microsoft Excel sheet was used to extract data. The pooled prevalence of pre-eclampsia was predicted using a random-effect model.

RESULTS

Twenty-nine studies were included. The pooled prevalence of pre-eclampsia was 11.51% (95% CI: 8.41, 14.61). Age > 35 years old (AOR = 2.34, 95%CI, 1.74-2.94; p-value = 0.64), housewife (AOR = 2.76, 95%CI, 1.2-4.32; p-value = 0.37), previous history of pre-eclampsia (AOR = 4.02, 95%CI, 2.91-5.55; p-value = 0.09), family history of hypertension (OR = 1.84, 95%CI, 1.39-2.3; p-value = 0.4), history of chronic hypertension (AOR = 2.44, 95%CI, 1.8-3.08; p-value = 0.67), history of multiple pregnancies (AOR = 1.45, 95%CI, 1.09-1.8; p-value = 0.38), and alcohol intake during pregnancy (AOR = 1.53, 95%CI, 1.03-2.04; p-value = 0.03) were the determinants of pre-eclampsia.

CONCLUSIONS

When compared to previous studies, the overall pooled prevalence of pre-eclampsia was high. Pre-eclampsia is associated with maternal age >35 years, being a housewife, having a history of preeclampsia, having a history of chronic hypertension, having a family history of hypertension, having diabetes mellitus, drinking alcohol during pregnancy, and having multiple pregnancies.

Retrospective Study of the Correlation Between Twin Pregnancies and Perinatal Outcome in Association to the Impact of Preterm Birth

Background

Twin pregnancies make up 2% to 4% of all births. Incidence of spontaneous twin pregnancies varies around the world, with percentages ranging from 8/1000 to >17/1000 births. The variation in twin pregnancy rates is thought to be due to dizygotic pregnancies, since monozygotic pregnancies have a consistent incidence of 3.5/1000 to 4/1000 births. The incidence of twin pregnancies after the widespread use of assisted reproduction has increased significantly.

Objective

The purpose of the present study is to investigate factors , who contribute to improve the perinatal outcome in twin pregnancies. Support will be provided by the results of twin pregnancies by the Department of Obstetrics and Gynaecology of Demokrition University of Thrace (Alexandroupolis, Greece) in the last fifteen years.

Methods

From the above Department, data were collected on the number of twin pregnancies, maternal age, gestational age, mode of delivery (spontaneous delivery or caesarean section), birth weight and rate of twin pregnancies with assisted reproduction.

Results

The results showed the increasing trend of twin pregnancies and births. A total of 304 twin pregnancies were identified (rate 2.75%). The rate of assisted reproduction was 34.83% in our sample, while the rate of cesarean deliveries was 95.5%, showing a large increase in recent years. In ten cases, normal delivery was successfully performed. The gestational age in twin pregnancies that ended with normal delivery was 37.37 + 3 weeks and the fetuses were both cephalic presentations. The main reason for admission of newborns to the NICU Department was prematurity.

Conclusion

The constantly improving education of perinatalists and understanding of the pathophysiology may lead to individualization of their treatment, and improvement of their prognosis based on recent scientific data from other international centers.

Adverse obstetric outcomes in women with PCOS and multiple gestations

RESEARCH QUESTION

Does multiple gestation alter the risks for adverse obstetric outcomes in women with polycystic ovary syndrome (PCOS)?

DESIGN

Retrospective population-based cohort study using data from the HCUP-NIS from 2004 to 2014. A total of 14,882 women with PCOS, who delivered within that time period, were identified. The study group comprised women with PCOS who had had a multiple gestation (n = 880); the reference group was comprised of the remaining women with PCOS and singleton gestation (n = 14,002).

RESULTS

In women with PCOS, multiple gestation increased the risks of pregnancy complications including pregnancy-induced hypertension (adjusted odds ratio [aOR] 2.030; 95% confidence interval [CI] 1.676-2.460), pre-eclampsia (aOR 2.879; 95% CI 2.277-3.639), pre-eclampsia and eclampsia superimposed on pre-existing hypertension (aOR 1.917; 95% CI 1.266-2.903) and gestational diabetes (aOR 1.358; 95% CI 1.114-1.656). Multiple gestation increases the risk of preterm premature rupture of membranes (aOR 5.807; 95% CI 4.153-8.119), preterm delivery (aOR 8.466; 95% CI 7.071-10.135), Caesarean section (aOR 5.146; 95% CI 4.184-6.329), post-partum haemorrhage (aOR 1.540; 95% CI 1.065-2.228) and the need for transfusion (aOR 3.268; 95% CI 2.010-5.314), as well as wound complications (aOR 3.089; 95% CI 1.647-5.794). Neonates born to mothers with PCOS and having multiple gestations are more likely to be small for gestational age when compared to singleton neonates born to mothers with PCOS (aOR 4.606; 95% CI 3.480-6.095). Among PCOS women with multiple gestations, obesity increased the risks of developing pregnancy-induced hypertension (P < 0.001), pre-eclampsia (P < 0.001) and wound complications (P = 0.045).

CONCLUSION

These results highlight the importance of single embryo transfer and ovulation induction to develop a single follicle in women with PCOS. Obesity further increases obstetrical complications.

Calcium, Potassium, Sodium, and Magnesium Concentrations in the Placenta, Umbilical Cord, and Fetal Membrane from Women with Multiple Pregnancies

Calcium (Ca), potassium (K), sodium (Na), and magnesium (Mg) are the elements responsible for the fundamental metabolic and biochemical processes in the cells of the body. The demand for these elements increases significantly during pregnancy, where an adequate supply protects women from the hypertension common in pre-eclampsia and preterm labor. This study aimed to evaluate the association between macro-elements (Ca, Mg, Na, and K) in the placenta, fetal membrane, and umbilical cord and the morphometric parameters of newborns from multiple pregnancies. The study involved 57 pregnant European women with healthy uncomplicated twin pregnancies (n = 52) and triple pregnancies (n = 5); 40 pairs of dichorionic diamniotic twins, 11 pairs of monochorionic diamniotic twins, 1 pair of monochorionic monoamniotic twins, 3 trichorionic triamniotic triplets, and 2 dichorionic triamniotic triplets. Placentas (n = 107), umbilical cords (n = 114), and fetal membranes (n = 112) were collected immediately following delivery, and then weighed and measured. The levels of Ca, K, Na, and Mg were determined using inductively coupled plasma atomic emission spectroscopy (ICP-OES) in a Thermo Scientific ICAP 7400 Duo (Waltham, MA, USA). The respective mean concentrations of Ca, K, Na, and Mg (mg/kg^-1 dry mass) were: 2466, 8873, 9323, and 436 in the placenta; 957, 6173, 26,757, and 326 in the umbilical cord, and 1252, 7460, 13,562, and 370 in the fetal membrane. In the studied materials from northwestern Poland, we found strong positive correlations between Ca and Mg concentrations in both the umbilical cord (r = 0.81, p = 0.00) and the fetal membrane (r = 0.73, p = 0.00); between K and Mg concentrations in the umbilical cord (r = 0.73, p = 0.00); between Ca and K concentrations in the fetal membrane (r = 0.73, p = 0.00), and we found moderately positive correlations between placental Ca concentration and placental weight (ρ = 0.42, p = 0.00) and between umbilical cord Mg concentrations and the length of the pregnancy (ρ = 0.42, p = 0.00). Negative correlations were found between Na and Ca concentrations in the fetal membrane (r = -0.40, p = 0.00) and Na concentrations in the fetal membrane and Mg concentrations in the placenta (r = -0.16, p = 0.02). Negative correlations were confirmed between the length of pregnancy and head circumference (ρ = -0.42; p = 0.00), infant weight (ρ = -0.42; p = 0.00), infant length (ρ = -0.49; p = 0.00), shoulder width (ρ = -0.49; p = 0.00); and between the infant weight and head circumference (ρ = -0.62; p = 0.00), weight before delivery (ρ = -0.36; p = 0.00), infant length (ρ = -0.45; p = 0.00), shoulder width (ρ = -0.63; p = 0.00), and weight gain during pregnancy (ρ = -0.31; p = 0.01). We found statistically significant correlations between cigarette smoking before pregnancy and the women's weight before delivery (ρ = 0.32, p = 0.00), and a negative correlation between the women's ages and infant head circumference (ρ = -0.20, p = 0.02). This is probably the first study to evaluate Ca, Na, K, and Mg concentrations in the afterbirth tissues of multiple pregnancies. It adds to the knowledge of elemental concentrations in multiple pregnancies and their possible effects on fetal morphometric parameters.

The Relationship between Angiogenic Factors and Energy Metabolism in Preeclampsia

Antiangiogenic factors are currently used for the prediction of preeclampsia. The present study aimed to evaluate the relationship between antiangiogenic factors and lipid and carbohydrate metabolism in maternal plasma and placenta. We analyzed 56 pregnant women, 30 healthy and 26 with preeclampsia (including early and late onset). We compared antiangiogenic factors soluble Fms-like Tyrosine Kinase-1 (sfLt-1), placental growth factor (PlGF), and soluble endoglin (sEng)), lipid and carbohydrate metabolism in maternal plasma, and lipid metabolism in the placenta from assays of fatty acid oxidation, fatty acid esterification, and triglyceride levels in all groups. Antiangiogenic factors sFlt-1, sFlt-1/PlGF ratio, and sEng showed a positive correlation with triglyceride, free fatty acid, and C-peptide maternal serum levels. However, there was no relationship between angiogenic factors and placental lipid metabolism parameters. Free fatty acids were predictive of elevated sFlt-1 and sEng, while C-peptide was predictive of an elevated sFlt1/PlGF ratio. The findings in this study generate a model to predict elevated antiangiogenic factor values and the relationship between them with different products of lipid and carbohydrate metabolism in maternal serum and placenta in preeclampsia.

Predictive value of the sFlt-1/PlGF ratio for preeclampsia in twin pregnancies: a retrospective study

Objective: This study aimed to investigate the efficiency of the soluble Fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio in predicting preeclampsia (PE) within 4 weeks in twin pregnancies.Methods: Seventy-eight women with serum angiogenic markers measured at 28 + 0 to 30 + 6 weeks of gestation were enrolled. A receiver-operating characteristic curve was used to determine the sFlt-1/PlGF ratio threshold to predict PE.Results: A cutoff value for the sFlt-1/PlGF ratio of 22.2 predicted PE presence within 4 weeks.Conclusion: An sFlt-1/PlGF ratio of ≤22.2 is potentially indicative of PE absence within 4 weeks in twin pregnancies.