Screening for preeclampsia in twin pregnancies. (November 2022)

• Record Type: Journal Article
• Authors: Francisco, Carla; Gamito, Mariana; Reddy, Maya; Rolnik, Daniel L.
• Is Part Of: Best practice & research. Volume 84(2022)
• Page Start: 55
• Page End: 65
• Publication Date: 2022-11
• Subjects: Preeclampsia -- Prediction -- Prevention -- Twins -- Multiple pregnancy -- Aspirin; Gynecology -- Periodicals; Obstetrics -- Periodicals; Genital Diseases, Female; Obstetrics; Gynecology; Obstetrics; Periodicals; 618.05
• DOI: 10.1016/j.bpobgyn.2022.03.008
• Languages: English
• ISSNs: 1521-6934

Abstract

Abstract: Twin pregnancies are an important risk factor for preeclampsia, a hypertensive disorder of pregnancy that is associated with a significant risk of maternal and perinatal morbidity. Given the burden of preeclampsia, the identification of women at high risk in early pregnancy is essential to allow for preventive strategies and close monitoring. In singleton pregnancies, the risk factors for preeclampsia are well established, and a combined first-trimester prediction model has been shown to adequately predict preterm disease. Furthermore, intervention with low-dose aspirin at 150 mg/day in those identified as high-risk reduces the rate of preterm preeclampsia by 62%. In contrast, risk factors for preeclampsia in twin pregnancies are less established, the proposed screening models have shown poor performance with high false-positive rates, and the benefit of aspirin for the prevention of preeclampsia is not clearly demonstrated. In this review, we examine the literature assessing prediction and prevention of preeclampsia in twin pregnancies. Highlights: Multiple pregnancies are at a significantly higher risk of preeclampsia. The risk of preeclampsia in twins is underestimated because preterm birth is more likely. Preeclampsia tends to occur earlier and is more severe in twin pregnancies. Prediction tools are improving but still underperform compared to prediction in singletons. The benefit of aspirin for the prevention of preeclampsia in twin pregnancies is unclear.