Abstract
Background
Hypertensive disorders of pregnancy (HDP) are associated with dysfunctional placentation and are a major cause of maternal and neonatal morbidity and mortality. Twin pregnancies have a larger placental mass and are a risk factor for HDP. The effect of HDP on neonatal outcomes in twin pregnancies is unknown.
Methods
Retrospective cohort study using the Canadian Neonatal Network database from 2010–2018 of twin infants <29 weeks gestation born to mothers with HDP and normotensive pregnancies. Using multivariable models, we determined adjusted odds ratios (AORs) and 95% confidence intervals (CI) for mortality, bronchopulmonary dysplasia, severe neurologic injury, severe retinopathy of prematurity (ROP), necrotizing enterocolitis, and nosocomial infection in twin infants of mothers with HDP compared to twin infants of normotensive mothers.
Results
Of the 2414 eligible twin infants <29 weeks gestational age, 164 (6.8%) were born to mothers with HDP and had higher odds of severe ROP (AOR 2.48, 95% CI 1.34–4.59). Preterm twin infants born to mothers with HDP also had higher odds of mortality (AOR 2.02, 95% CI 1.23–3.32). There was no difference in other outcomes.
Conclusion
Preterm twin infants <29 weeks gestation of HDP mothers have higher odds of severe ROP and mortality.
Impact
Hypertensive disorders of pregnancy, associated with placental dysfunction, are a major cause of maternal and neonatal morbidity and mortality.
Twin pregnancy, associated with a larger placental mass, is a risk factor for hypertensive disorders of pregnancy.
The effect of hypertensive disorders of pregnancy on outcomes of preterm twins is unknown.
Preterm twins of mothers with hypertensive disorders of pregnancy are at higher risk of severe retinopathy of prematurity and mortality.
Our data can be used to counsel parents and identify infants at higher risk of severe retinopathy of prematurity and mortality.
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Acknowledgements
The authors thank all site investigators and data abstractors of the Canadian Neonatal Network (CNN) and the Canadian Neonatal Follow-Up Network (CNFUN). Full lists of Network member investigators and their affiliations appear in Supplementary Information. We thank Heather McDonald-Kinkaid, PhD, of the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada, for editorial support in preparing this manuscript; and other MiCare staff, for organizational support. MiCare is supported by the Canadian Institutes of Health Research, the Ontario Ministry of Health and Long-Term Care, and the participating hospitals.
Funding
Although no specific funding was received for this study, organizational support for the Canadian Neonatal Network and the Canadian Neonatal Follow-Up Network was provided by the Maternal-infant Care Research Centre (M.C.) at Mount Sinai, Hospital in Toronto, Ontario, Canada. M.C. is supported by a Canadian Institutes of Health, Research (CIHR) Team Grant (CTP 87518), the Ontario Ministry of Health and Long-Term, Care, and the participating hospitals. P.S.S. holds a CIHR Applied Research Chair in Reproductive, and Child Health Services and Policy Research (APR-126340).
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K.Y.: Concept and design, supervised and revised the proposal, drafting of the manuscript, revision of the manuscript. K.Y.: Wrote the proposal, interpreted data, drafting of manuscript, revision of the manuscript. B.A.: Reviewed proposal, interpreted data, revision and critical appraisal of the manuscript. S.H.: Reviewed proposal, interpreted data, revision, and critical appraisal of the manuscript. D.L.: Interpreted data, revision, and critical appraisal of the manuscript. J.E.: Interpreted data, revision, and critical appraisal of the manuscript. M.C.: Interpreted data, revision, and critical appraisal of the manuscript. M.B.: Revision and critical appraisal of the manuscript, acquisition and analysis of data. P.S.S.: Revision and critical appraisal of the manuscript, acquisition, and analysis of data. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work in ensuring that questions related to its accuracy or integrity are appropriately investigated and resolved.
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A retrospective cohort study using anonymized data form a large data base. The study was approved by the Conjoint Health Research Ethics Board University of Calgary.
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Yurkiw, K., Alshaikh, B., Hasan, S.U. et al. Neonatal outcomes of twins <29 weeks gestation of mothers with hypertensive disorders of pregnancy. Pediatr Res 92, 748–753 (2022). https://doi.org/10.1038/s41390-022-02044-5
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DOI: https://doi.org/10.1038/s41390-022-02044-5
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