title: Effect of maternal chronic disease on obstetric complications in twin pregnancies in a United States cohort.
abstract: OBJECTIVE
  To evaluate the effect of maternal chronic disease on obstetric complications among twin pregnancies.
  
  
  METHODS
  Multicenter, retrospective, observational study.
  
  
  METHODS
  Clinical centers (19 hospitals).
  
  
  METHODS
  Twin pregnancies (n = 4,821) delivered ≥ 23 weeks of gestation and classified by maternal chronic disease (either none or any of the following: asthma, depression, hypertension, diabetes, and heart, thyroid, gastrointestinal or renal disease).
  
  
  METHODS
  None.
  
  
  METHODS
  Gestational age at delivery, gestational hypertension, pre-eclampsia, gestational diabetes, placental abruption, placenta previa, hemorrhage, chorioamnionitis, maternal postpartum fever, premature rupture of membranes, labor onset (spontaneous vs. nonspontaneous), route of delivery, and maternal admission to intensive care unit.
  
  
  RESULTS
  Women with chronic disease delivered earlier (mean gestational length, 34.1 vs. 34.6 weeks) and were less likely to have term birth (risk ratio 0.80; 95% confidence interval 0.70-0.90). Cesarean delivery after spontaneous labor (risk ratio 1.20; 95% confidence interval 1.05-1.37) was also increased with chronic disease. No statistically significant effects were observed for other complications studied. Women who used assisted reproductive technology were more likely to hemorrhage, independent of chronic disease, but other findings were generally similar to the non-assisted reproductive technology sample.
  
  
  CONCLUSIONS
  Chronic disease was associated with additional risk of earlier delivery and cesarean section after spontaneous labor in a nationwide sample of US twin pregnancies.
authors.affiliation: Epidemiology Branch, Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20852, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Werder
authors.forename: Pauline
authors.initials: P
authors.lastname: Mendola
authors.forename: Tuija
authors.initials: T
authors.lastname: Männistö
authors.forename: Jennifer
authors.initials: J
authors.lastname: O'Loughlin
authors.forename: S Katherine
authors.initials: SK
authors.lastname: Laughon
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000639:trends; D002908:Chronic Disease; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000639:trends; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology*; D059285:Pregnancy, Twin / Q000502:physiology; D047928:Premature Birth / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
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