Gestational hypertensive disease in twin pregnancy: Influence on outcomes in a large national prospective cohort.
OBJECTIVE
Gestational hypertensive disease (GHD) is associated with pregnancy-related complications and poor maternal and fetal outcomes in singleton pregnancies. We sought to examine the influence of GHD in a large prospective cohort of twin pregnancies.


METHODS
The ESPRIT study was a national multicenter observational cohort study of 1028 structurally normal twin pregnancies. Each pregnancy underwent sonographic surveillance with two-week ultrasound from 24 weeks for dichorionic and from 16 weeks for monochorionic gestations. Characteristics and demographics as well as labour and delivery outcome data were prospectively recorded. Perinatal mortality, admission to the neonatal intensive care unit (NICU) and a composite of morbidity of respiratory distress syndrome, hypoxic ischaemic encephalopathy, periventricular leukomalacia, necrotising enterocolitis and sepsis were documented for all cases. Outcomes for patients with documented GHD (pre-eclampsia and gestational hypertension) were compared with those without GHD.


RESULTS
Perinatal outcome data were recorded for 977 patients. Women with GHD had a higher body mass index (27.1 ± 6.4 vs 25.2 ± 4.5, P < 0.0001) than those without and were more likely to be nulliparous (65% (59/92) vs 46% (407/885), P = 0.001). Both groups had similar mean birthweights, but those with GHD were more likely to have a birthweight discordance ≥18% (35% (32/92) vs 20% (179/885), P = 0.001). Rates of caesarean delivery were higher in those twin pregnancies affected by GHD, and while the rate of composite morbidity was similar in both groups, twins in the GHD group had higher rates of NICU admission.


CONCLUSIONS
In twin gestations, gestational hypertension independently confers an increased risk for emergency caesarean delivery, birthweight discordance and NICU admission, such that intensive maternal-fetal monitoring is justified when hypertension develops in a twin pregnancy.
Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland. markhehir23@gmail.com.
Mark P
MP
Hehir
Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland.
Fionnuala M
FM
Breathnach
Department of Obstetrics and Gynaecology, University College Dublin School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
Fionnuala M
FM
McAuliffe
Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland.
Michael P
MP
Geary
Department of Obstetrics and Gynaecology, Coombe Women's and Infants' University Hospital, Dublin, Ireland.
Sean
S
Daly
Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.
John
J
Higgins
Department of Obstetrics and Gynaecology, Royal Victoria Maternity Hospital Belfast, Belfast, UK.
Alyson
A
Hunter
Department of Obstetrics and Gynaecology, National University of Ireland Galway, Galway, Ireland.
John J
JJ
Morrison
Department of Obstetrics and Gynaecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
Gerard
G
Burke
Department of Obstetrics and Gynaecology, Our Lady of Lourdes Hospital, Drogheda, Ireland.
Shane
S
Higgins
Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland.
Rhona
R
Mahony
Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland.
Patrick
P
Dicker
Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland.
Elizabeth C
EC
Tully
Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland.
Fergal D
FD
Malone
D001724:Birth Weight; D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D010298:Parity; D011247:Pregnancy; D059285:Pregnancy, Twin; D015995:Prevalence; D011446:Prospective Studies
delivery; hypertension; pre-eclampsia; twins