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Background <p>Hypertensive disorders of pregnancy (HDP) significantly impact infant outcomes. However, evidence regarding HDP’s effects on twin pregnancies remains limited and poorly characterized. This study aimed to investigate the impact of HDP on perinatal outcomes and neonatal complications in twin pregnancies.</p> Methods <p>Data were collected from 22 medical centers across 12 Chinese provinces between January 2018 and December 2020. The primary variable of interest was HDP (including gestational hypertension and preeclampsia). Perinatal outcomes and neonatal complications were systematically assessed using multivariable logistic regression, propensity score matching, and overlap weighting (OW).</p> Results <p>Among 6,307 twin pregnancies, 1,013 cases (16.1%) were diagnosed with HDP. HDP significantly increased the likelihood of preterm birth (2.68 [2.27–3.15] <sub>OW</sub>). Specifically, it elevated the rates of early and late preterm births (1.29 [1.00-1.67] <sub>OW</sub> and 2.31 [2.00-2.68] <sub>OW</sub>, respectively), while reducing the risk of extremely preterm births (0.32 [0.12–0.77] <sub>OW</sub>). Moreover, HDP was associated with increased rates of low birth weight and small-for-gestational-age (OW-OR [95%CI] of 1.54 [1.34–1.78] and 1.18 [1.00-1.42], respectively), and heightened risk of birth weight discordance (&gt; 15%, &gt; 20%, and &gt; 25%). For twin complications, HDP elevated oxygen requirement (1.29 [1.07–1.56] <sub>OW</sub>), 1-minute Apgar scores &lt; 7 (1.29 [1.07–1.56] <sub>OW</sub>), and NICU admissions (1.58 [1.32–1.90] <sub>OW</sub>). Stratified and sensitivity analyses reaffirmed the robustness.</p> Conclusions <p>HDP increases adverse perinatal and neonatal outcomes in twins. Therefore, careful monitoring and management are imperative for mothers diagnosed with HDP carrying twins to mitigate these adverse outcomes.</p> Trial registration <p>NA.</p>

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The impact of hypertensive disorders of pregnancy on perinatal outcomes in twin pregnancies: a national multi-center cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月1日

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  • Zhoushan Feng,
  • Chunhong Jia,
  • Xiao-mei Tong,
  • Zheng He,
  • Chunxia Yang,
  • Wei Shen,
  • Yueqin Ding,
  • Jin Liu,
  • Qiong Meng,
  • Aiqin Zhang,
  • Hong Jiang,
  • Wenkang Yan,
  • Jianwu Qiu,
  • Xian Wei,
  • Yayu Zhang,
  • Xiaobo Lin,
  • Lijun Liu,
  • Ya Jin,
  • Youfen Wei,
  • Weixing Zhang,
  • Xiufang Yang,
  • Yitong Wang,
  • Yangfan Cai,
  • Fan Wu,
  • Qiliang Cui

摘要

Background

Hypertensive disorders of pregnancy (HDP) significantly impact infant outcomes. However, evidence regarding HDP’s effects on twin pregnancies remains limited and poorly characterized. This study aimed to investigate the impact of HDP on perinatal outcomes and neonatal complications in twin pregnancies.

Methods

Data were collected from 22 medical centers across 12 Chinese provinces between January 2018 and December 2020. The primary variable of interest was HDP (including gestational hypertension and preeclampsia). Perinatal outcomes and neonatal complications were systematically assessed using multivariable logistic regression, propensity score matching, and overlap weighting (OW).

Results

Among 6,307 twin pregnancies, 1,013 cases (16.1%) were diagnosed with HDP. HDP significantly increased the likelihood of preterm birth (2.68 [2.27–3.15] OW). Specifically, it elevated the rates of early and late preterm births (1.29 [1.00-1.67] OW and 2.31 [2.00-2.68] OW, respectively), while reducing the risk of extremely preterm births (0.32 [0.12–0.77] OW). Moreover, HDP was associated with increased rates of low birth weight and small-for-gestational-age (OW-OR [95%CI] of 1.54 [1.34–1.78] and 1.18 [1.00-1.42], respectively), and heightened risk of birth weight discordance (> 15%, > 20%, and > 25%). For twin complications, HDP elevated oxygen requirement (1.29 [1.07–1.56] OW), 1-minute Apgar scores < 7 (1.29 [1.07–1.56] OW), and NICU admissions (1.58 [1.32–1.90] OW). Stratified and sensitivity analyses reaffirmed the robustness.

Conclusions

HDP increases adverse perinatal and neonatal outcomes in twins. Therefore, careful monitoring and management are imperative for mothers diagnosed with HDP carrying twins to mitigate these adverse outcomes.

Trial registration

NA.