A Review of Research Progress of Pregnancy with Twins with Preeclampsia

Figures & data

Figure 1 The pathogenesis of twin preeclampsia, from the characteristics of twin, twin placenta area is larger, produce more anti angiogenic substances, assisted reproductive technology is widely used, old age, obesity and maternal primary disease increase, immune disorders, the role of genetic factors, from many aspects reveals the mechanism of the occurrence and development of twin preeclampsia.

Abbreviations: MMPs, matrix metalloproteinases; sflt1, soluble FMS like tyrosine kinase 1; PlGF, placental growth factor.

Table 1 Summary of Studies on the Clinical Features of Twins

Author	Country	Year	Experimental Model	Outcome	Result	Ref.
Svirsky	Israel	2014	147 twins and 110 singleton	MAP and PI Variability	In the twins with preeclampsia, map (mean arterial pressure) was significantly higher than that in the twins without preeclampsia (P < 0.02, one tailed), while the level of Doppler PI (Doppler pulse index) was significantly lower. (P < 0.01, two tailed)	[^Citation50]
Chen	Japan	1998	24 twins and 99 singleton	PI Variability	The mid-term Doppler PI level of twin pregnancy was lower than that of singleton pregnancy	[^Citation51]
Mourad	USA	2021	614 twins	The rate of hypertensive disorders of pregnancy in the GDM group	After adjusting for mother’s age, in vitro fertilization treatment, race and pre pregnancy body mass index, the study found that there was no difference in the incidence of hypertension during pregnancy between women with and without gestational diabetes	[^Citation52]
Mor	Israel	2020	135 twins and 63 singleton	The rate of gestational hypertensive disorders (preeclampsia and gestational hypertension)	Compared with twin pregnancy, the incidence of hypertensive disorder complicating pregnancy (preeclampsia and gestational hypertension) was similar, but the rates of severe preeclampsia trended higher In twins (8 (5.9%) vs 0, p=0.057).	[^Citation53]
Petersen	Norway	2020	125,708 singleton, 20,668 twins	The rate of gestational hypertensive disorders	The study found that the risk of hypertension in twins after natural pregnancy or assisted reproductive technology was increased, but after assisted reproductive technology pregnancy (risk difference, 1.73 percentage points every 5 years; confidence interval, 95%, 1.35–2.11 percentage points every 5 years) was higher than that in twins after natural pregnancy (risk difference, 0.75 percentage points; confidence interval, 95%, 1.35–2.11 percentage points every 5 years); The confidence interval was 95%, 0.61–0.89 percentage points every five years)	[^Citation45]
Aviram	Canada	2018	144 twins and 768 singleton	SGA (small for gestational age) and maternal vascular malperfusion (MVM)	Compared with preeclampsia singletons, twins had higher mean birth weight, lower small for gestational age (SGA) and fewer births < 34 weeks and < 32 weeks. The incidences of placental weight < 10% (AOR 0.49, 95% CI 0.33–0.71), fetal vascular pathology (AOR 0.28, 95% CI 0.20–0.39) and fetal vascular perfusion pathology (AOR 0.65, 95% CI 0.45–0.93) were lower. The results support the hypothesis that MVM has little relationship with the pathogenesis of HDP in twin pregnancy, and suggest that other placental or non placental factors are the reasons for the increased risk in twin pregnancy	[^Citation54]
Francisco	UK	2017	93,297 singleton, 1789 DC twin and in 430 MC twin	The relative risk of preterm PE	The relative risk of pre term PE in DC and MC twins is similar and substantially higher than in singleton pregnancies	[^Citation11]
Henry	USA	2013	3244 twins	The rates of severe preeclampsia	The severity of preeclampsia in twin pregnancy was higher than that in singleton pregnancy	[^Citation46]
Foo	Australia	2012	3942 singleton and 214 twins	SGA, The rates of preeclampsia	There was no difference in perinatal mortality	[^Citation55]
Hiersch	China	2019	333 twins	SGA, The rates of preeclampsia	GDM has a greater impact on MCDA twin pregnancy, manifested as maternal hypertensive disorder complicating pregnancy and SGA	[^Citation49]
Connolly	USA	2016	63 twin and 339 singleton	Morbidity and mortality by severe preeclampsia.	Mothers and neonates of twin pregnancies complicated by preeclampsia do not appear to have greater morbidity and mortality compared to mothers and neonates of singleton pregnancies.	[^Citation57]
Foo JY	Australia	2013	214 twin and 3942 singleton	SGA, The rates of preeclampsia	The possibility of PE in twin pregnancy with chronic hypertension was higher than that in singleton pregnancy (P < 0.01). The gestational age of twin pregnancy with PE was earlier (P < 0.001), and SGA was more.	[^Citation56]
Laine	Norway	2019	16,174 twin	The rate of gestational hypertensive disorders	The risk of preeclampsia in twin pregnancies was higher than previously reported, additionally, the prevalence of preeclampsia in twin pregnancies was three to four times higher than that of singleton pregnancies	[^Citation42]
Savvidou	UK	2001	171 MC and 495 DC	The incidence of pre-eclampsi	No difference in the risk of preeclampsia between monozygotic chorionic twins and dizygotic chorionic twins	[^Citation48]

Abbreviations: DC, dichorionic; GDM, gestational diabetes mellitus; HDP, hypertensive disorders in pregnancy; MAP, mean arterial pressure; MVM, maternal vascular malperfusion; MC, monochorionic; MCDA, monochorionic diamniotic twin; PI, pulse index; PE, preeclampsia; SGA, small for gestational age.

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