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Impact of stage 1 hypertension before 20 gestational weeks on pregnancy outcomes in twin pregnancies: a retrospective cohort study

Hypertension Research volume 48, pages 914–926 (2025)Cite this article

A Comment to this article was published on 17 December 2024

Abstract

To explore the association between stage 1 hypertension before 20 weeks of gestation and twin pregnancy outcomes and to examine whether the association varies by prepregnancy BMI, conception mode, or chorionicity, we conducted a single-center, retrospective, hospital-based cohort study. All women who delivered twins between July 2014 and December 2020 were recruited. Logistic regression and linear regression models were used to identify associations. Among the 2069 included twin pregnancies, 1326 had normotension (< 130/80 mm Hg), and 743 had stage 1 hypertension (130–139/80–89 mm Hg). Compared with normotension, stage 1 hypertension was associated with higher risks of hypertension disorders of pregnancy (adjusted OR: 2.07, 95% CI: 1.62 ~ 2.64), gestational hypertension (adjusted OR: 3.99, 95% CI: 2.42 ~ 6.58), preeclampsia (adjusted OR: 1.71, 95% CI: 1.30 ~ 2.25), early preterm birth (adjusted OR: 1.58, 95%CI: 1.16 ~ 2.15), and small for gestational age (adjusted OR:1.45, 95%CI: 1.20 ~ 1.75). In particular, there were interaction effects between chorionicity and stage 1 hypertension on the risk of early preterm birth (Pinteraction = 0.014). In conclusion, stage 1 hypertension before 20 weeks of gestation is associated with a higher risk of adverse outcomes in twin pregnancies, and the associations vary by prepregnancy BMI and chorionicity. Obstetricians should take this into careful consideration during prenatal care to mitigate the potential risks of twins.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We sincerely thank all patients and hospital staff members who contributed to this study.

Funding

This study was supported by the Key Medical Engineering Cross Project of Shanghai Jiao Tong University (No.YG2023ZD26) and the National Key Research and Development Program of China (2023YFC2705900).

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Author notes

  1. These authors contributed equally: Yuanqing Xia, Yunfan Yang.

Authors and Affiliations

  1. Division of Fetal Medicine, Prenatal Diagnosis Department, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China

    Yuanqing Xia, Yunfan Yang, Xiaohan Su, Renyi Hua, Li Gao, Shuping Lyu, Yuru Tan, Dongjian Yang, Lu Liu & Yanlin Wang

  2. Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China

    Yuanqing Xia, Yunfan Yang, Xiaohan Su, Renyi Hua, Li Gao, Shuping Lyu, Yuru Tan, Dongjian Yang & Yanlin Wang

  3. Shanghai Municipal Key Clinical Specialty, Shanghai, 200030, China

    Yuanqing Xia, Yunfan Yang, Xiaohan Su, Renyi Hua, Li Gao, Shuping Lyu, Yuru Tan, Dongjian Yang & Yanlin Wang

  4. School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Patrick Manson Building, 7 Sassoon Road, Hong Kong, China

    Yuanqing Xia

  5. School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China

    Yiting Chen

  6. School of Life Course and Population Sciences, King’s College London, London, UK

    Lu Liu

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  1. Yuanqing Xia
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Correspondence to Dongjian Yang, Lu Liu or Yanlin Wang.

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Xia, Y., Yang, Y., Su, X. et al. Impact of stage 1 hypertension before 20 gestational weeks on pregnancy outcomes in twin pregnancies: a retrospective cohort study. Hypertens Res 48, 914–926 (2025). https://doi.org/10.1038/s41440-024-02001-1

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