title: Twin pregnancy: is it a risk factor for long-term cardiovascular disease?
abstract: OBJECTIVE
  To investigate whether twin pregnancy increases the risk for long-term maternal cardiovascular disease (CVD).
  
  
  METHODS
  A retrospective population-based cohort study compared the incidence of long-term CVD in a cohort of women with and without a previous twin delivery.
  
  
  METHODS
  Deliveries occurred between the years 1988 and 2012.
  
  
  METHODS
  Patients who had a twin birth between years 1988 and 2012 were included in the study, patient that had a singleton delivery included in the control group.
  
  
  METHODS
  CVD was divided into four categories according to severity and type. Kaplan-Meier survival curve was used to estimate cumulative incidence of cardiovascular hospitalizations. Cox proportional hazards model was used to estimate the adjusted hazard ratios (HR) for CVD.
  
  
  RESULTS
  During the study period, there were 100 387 women that met the inclusion criteria, 4.6% (n = 4647) delivered twins at least once during the period. The incidence of CVD was 1% in women who had a twin delivery and 1.12% in women who had a singleton delivery. There was no difference in the cumulative incidence of cardiovascular hospitalizations among women who had twin deliveries as compared with singletons. When performing a Cox proportional hazard model, a history of twin delivery did not increase the risk for long-term maternal cardiovascular hospitalizations (adjusted HR = 1.0, 95% CI = 0.8-1.1, p = 0.698).
  
  
  CONCLUSIONS
  Twin pregnancy is not associated with an increased risk for long-term maternal CVD.
authors.affiliation: a Department of Obstetrics and Gynecology , Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva , Israel and.
authors.forename: Rania
authors.initials: R
authors.lastname: Okby
authors.affiliation: b Department of Public Health , Ben-Gurion University of the Negev , Beer-Sheva , Israel.
authors.forename: Ilana
authors.initials: I
authors.lastname: Shoham-Vardi
authors.affiliation: b Department of Public Health , Ben-Gurion University of the Negev , Beer-Sheva , Israel.
authors.forename: Ruslan
authors.initials: R
authors.lastname: Sergienko
authors.affiliation: a Department of Obstetrics and Gynecology , Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva , Israel and.
authors.forename: Eyal
authors.initials: E
authors.lastname: Sheiner
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D011247:Pregnancy; D059285:Pregnancy, Twin / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Fertility treatment; long term cardiovascular disease; twin pregnancy