Clinical Features and Outcomes of Twin Pregnancies with Antiphospholipid Antibodies Positivity: A Retrospective Study

Abstract

Objective

This study aimed to evaluate the impact of twin pregnancies with antiphospholipid antibody (aPL) positivity, a rare and complex clinical condition that remains a huge challenge for management.

Methods

This study enrolled twin-pregnant women at our hospital between January 2018 and August 2023. Women with and without aPL positivity were selected using propensity score matching (PSM). Clinical features and pregnancy outcomes were compared between the two groups in the PSM cohort. To analyze the effect of aPL positivity on pregnancy outcomes, multivariate logistic models were used to obtain adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Results

Among the 773 women with twin pregnancies, aPL positivity was found in 26 women (3.36%). In the PSM cohort, there were 24 twin-pregnant women with positive aPL, and 48 women without aPL were selected as controls. Twin-pregnant women with aPL positivity had a higher proportion of abortion (8.33% vs 0, P = 0.043), preterm birth < 34 weeks (33.33% vs 8.33%, P = 0.007) and very low birthweight (<1500 g) (20.83% vs 4.17%, P = 0.016) than the control group. In addition, stillbirth of one fetus was observed in one twin-pregnant woman with positive aPL. Multivariate logistic regression analysis revealed that twin pregnancy with aPL positivity was associated with preterm birth < 34 weeks (aOR = 2.76, 95% CI: 0.83–4.70, P = 0.005), very low birthweight (<1500 g) (OR = 2.40, 95% CI: 0.18–4.67, P = 0.034) and small for gestational age (SGA) (aOR = 1.66, 95% CI: 0.22–3.10, P =0.024).

Conclusion

Twin pregnancies with aPL positivity were correlated with obstetric complications, including abortion, preterm birth < 34 weeks and very low birthweight (<1500 g). The detection of aPL may be of clinical significance for women with twin pregnancies and should be considered in future studies.

Keywords:

• twin pregnancy
• antiphospholipid antibody
• pregnancy outcomes
• propensity score matching

Ethics Approval

This study was performed in accordance with the principles of the Declaration of Helsinki and approved by the Ethics Committee of Tianjin Medical University General Hospital (number: IRB2020-KY-102). Written informed consent about the access to the patients’ medical record was not required, because this study was retrospective and the data were retrieved from electronic medical records. And patients’ identities were anonymous and all information was maintained with strict confidentiality.

Acknowledgments

We would like to thank all the participants in this study.

Disclosure

The authors declare no conflicts of interest in this work.

Additional information

Funding

This study was supported by the National Nature Science Foundation of China (Grant 82071674), Beijing-Tianjin-Hebei Basic Research Cooperation Project (22JCZXJC00160), Tianjin Health Science and Technology Project (TJWJ2022XK003), Tianjin Science and Technology Planning Project (21JCYBJC01080) and Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-031A).