Clinical Features For Early-and Late-onset Preeclampsia In Twin Pregnancies

Objective: To determine the perinatal outcomes and risk factors of twin pregnancies with early-onset preeclampsia(EOPE)and late-onset preeclampsia(LOPE),which provides theoretical basis for the clinical treatment and prevention of twin pregnancy with preeclampsia(PE).Methods: Analysis of a retrospective recorded database of 217 twin pregnancies with PE and 443 normal twin pregnancies.All of the patients hospitalized at the Shengjing Hospital of China Medical University from January 2014 to August 2017.The PE patients were divided into two groups: EOPE group develops before 34 weeks of pregnancy were 127,LOPE group develops after 34 weeks of pregnancy were 90.Study of EOPE's risk factors: 127 EOPE were case group,533 were control group including LOPE group and normal twin pregnancies.Study of LOPE's risk factors: 90 LOPE were case group,433 normal twin pregnancies were control group.Patients in EOPE group ranged in age from 18 to 45,with an average age of 31.37±5.08.Patients in LOPE group ranged in age from 19 to 39,with an average age of 31.36±4.26.The study used SPSS 18.0 statistical software to analyze the data by the means of t test and chi-square test.For the risk factors,univariate analysis was first,and then the significant factors were analyzed by multivariate logistic regression(P<0.05,the difference is statistical significance).Compare general information,maternal and infant outcomes and risk factors of EOPE and LOPE.Results: 1.Perinatal outcomes: there were differences in delivery mode,preterm birth rate and gestational weeks of termination(P<0.05).However,the incidence of complications including intrauterine fetal distress,hypoproteinemia and placental abruption had no significant differences(P>0.05).The preterm birth rate of EOPE group was 92.1% and the average gestational weeks was 33.66±2.71 weeks.LOPE group was 67.8% and 36.35±0.99 weeks.In both groups,cesarean section was the main delivery mode.Among the cesarean section patients,69 cases had iatrogenic termination of pregnancy,while the rest were normal labors.The rate of vaginal delivery was higher in the EOPE group,there are 11 cases through vaginal delivery,however the LOPE group was 0 case.Most of them terminated pregnancy between 25 and 32 weeks,two of them due to the aggravation of PE and accompanied by headache,fetal intrauterine growth restriction induced iatrogenic termination of pregnancy and others were normal labors.2.Neonatal outcomes: The EOPE group had longer hospital stays and higher hospitalization rate of newborns than LOPE group(P<0.05).The neonatal weight and Apgar scores in the EOPE group were lower than the LOPE group(P<0.05).The average birth weight of EOPE group was 1862.97±723.66 g,while that of LOPE group was 2434.64±442.48 g.There was no difference in fetal mortality between the two groups(P>0.05).3.Risk factors: In this study of twin pregnancies complicated by EOPE,univariate analysis showed that pregestational overweight(adjusted odds ratio [aOR]: 1.867,95% confidence interval [CI]:1.182–2.950),irregular prenatal examination(aOR 3.600,95%CI: 1.081–11.988)were statistically significant(P < 0.05),while there were no significant differences in advanced age(age ? 35 years),primiparity,assisted reproductive technology,etc.(P > 0.05).Multivariate logistic regression analysis showed that pregestational overweight(aOR 1.771,95%CI: 1.113–2.816)was an significant risk factor for EOPE in twin pregnancies(P < 0.05).Risk factors for LOPE in twin pregnancies,univariate analysis showed that conception in winter(aOR 2.054,95%CI: 1.101–3.834),primiparity(aOR 3.190,95%CI: 1.250–8.146)and dichorionic pregnancy(aOR 2.158,95%CI: 1.177–3.956)were statistically significant(P < 0.05),while there were no significant differences in advanced age(age ? 35 years),pregestational BMI,assisted reproductive technology,etc.(P > 0.05).Multivariate logistic regression analysis showed that conception in winter(aOR 2.207,95%CI: 1.170–4.164),primiparity(aOR 2.997,95%CI: 1.163–7.725)and dichorionic pregnancy(a OR 2.091,95%CI: 1.127–3.880)were significant risk factors for LOPE in twin pregnancies(P < 0.05).Conclusion:Twin pregnancies with EOPE have a greater risk for vaginal delivery,premature delivery and low birth weight newborns.In addition,EOPE also have earlier gestational weeks of termination,higher hospitalization rates and longer hospital stay of newborns.The risk factors of EOPE and LOPE are different.This study found that pregestational overweight is an independent risk factor for EOPE,so it is expected to prevent the occurrence of EOPE by controlling pregestational weight.In addition,winter conception,primiparity and dichorionic pregnancy are independent risk factors for LOPE,so controlling the season of conception and limiting the number of transplanted blastocysts during assisted reproductive technology may also help prevent the occurrence of LOPE in twin pregnancies.