Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

Open Access 01-12-2020 | Pre-Eclampsia | Research article

Maternal cardiovascular adaptation to twin pregnancy: a population-based prospective cohort study

Authors: Maria C. Adank, Zoe A. Broere-Brown, Romy Gonçalves, M. Kamran Ikram, Vincent W. V. Jaddoe, Eric A. P. Steegers, Sarah Schalekamp-Timmermans

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Login to get access

Abstract

Background

In women with singleton pregnancies, maternal adaptation is considered a stress test for later life cardiovascular disease. The aim of this study was to assess maternal adaptation in women with twin pregnancies compared to women carrying singletons during and after pregnancy.

Methods

This was a population based prospective cohort study of 91 women with twin pregnancies and 8107 women carrying singletons. The association of twin pregnancy and maternal adaptation was examined using regression analyses. In pregnancy, we measured soluble fms-like tyrosine kinase-1 (sFLT-1), placental growth (PGF) factor, systolic (SBP) and diastolic blood pressure (DBP), and the occurrence of pre-eclampsia (PE). After pregnancy, measurements were obtained on SBP and DBP, cardiac function, retinal calibres, intima media thickness and distensibility of the common carotid artery.

Results

sFLT-1 and PGF concentrations were higher in early (13.4 weeks) and mid-pregnancy (20.4 weeks) in women with twin pregnancies compared to women with singleton pregnancies. Women with twin pregnancies had a different DBP pattern in pregnancy. Women with twin pregnancies were more likely to have PE (odds ratio 3.63; 95% CI [1.76 to 7.48]). Six and ten years after pregnancy, no differences in maternal adaptation were observed.

Conclusions

Women with twin pregnancies show an altered adaptation during pregnancy compared to women with singleton pregnancies. This is associated with a substantially increased incidence of PE, but does not lead to persistent altered maternal adaptation years after pregnancy.
Appendix
Available only for authorised users
Literature
1.
Bellamy L, Casas JP, Hingorani AD, et al. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007;335(7627):974.PubMedPubMedCentralCrossRef
2.
Germain AM, Romanik MC, Guerra I, et al. Endothelial dysfunction: a link among preeclampsia, recurrent pregnancy loss, and future cardiovascular events? Hypertension. 2007;49(1):90–5.PubMedCrossRef
3.
Sattar N, Greer IA. Pregnancy complications and maternal cardiovascular risk: opportunities for intervention and screening? BMJ. 2002;325(7356):157–60.PubMedPubMedCentralCrossRef
4.
Coonrod DV, Hickok DE, Zhu K, et al. Risk factors for preeclampsia in twin pregnancies: a population-based cohort study. Obstet Gynecol. 1995;85(5 Pt 1):645–50.PubMedCrossRef
5.
Campbell DM, MacGillivray I. Preeclampsia in twin pregnancies: incidence and outcome. Hypertens Pregnancy. 1999;18(3):197–207.PubMedCrossRef
6.
Long PA, Oats JN. Preeclampsia in twin pregnancy--severity and pathogenesis. Aust N Z J Obstet Gynaecol. 1987;27(1):1–5.PubMedCrossRef
7.
Ros HS, Cnattingius S, Lipworth L. Comparison of risk factors for preeclampsia and gestational hypertension in a population-based cohort study. Am J Epidemiol. 1998;147(11):1062–70.PubMedCrossRef
8.
Yu CK, Papageorghiou AT, Boli A, et al. Screening for pre-eclampsia and fetal growth restriction in twin pregnancies at 23 weeks of gestation by transvaginal uterine artery Doppler. Ultrasound Obstet Gynecol. 2002;20(6):535–40.PubMedCrossRef
9.
Bdolah Y, Lam C, Rajakumar A, et al. Twin pregnancy and the risk of preeclampsia: bigger placenta or relative ischemia? Am J Obstet Gynecol. 2008;198(4):428 e1–6.CrossRef
10.
Wang YA, Chughtai AA, Farquhar CM, et al. Increased incidence of gestational hypertension and preeclampsia after assisted reproductive technology treatment. Fertil Steril. 2016;105(4):920–6 e2.PubMedCrossRef
11.
Russell RB, Petrini JR, Damus K, et al. The changing epidemiology of multiple births in the United States. Obstet Gynecol. 2003;101(1):129–35.PubMed
12.
Bortolus R, Parazzini F, Chatenoud L, et al. The epidemiology of multiple births. Hum Reprod Update. 1999;5(2):179–87.PubMedCrossRef
13.
Bulmer. The Biology of Twinning in Man. New York: Clarendon; 1970.
14.
15.
Kooijman MN, Kruithof CJ, van Duijn CM, et al. The generation R study: design and cohort update 2017. Eur J Epidemiol. 2016;31(12):1243–64.PubMedCrossRef
16.
Kruithof CJ, Kooijman MN, van Duijn CM, et al. The generation R study: biobank update 2015. Eur J Epidemiol. 2014;29(12):911–27.PubMedCrossRef
17.
Coolman M, Timmermans S, de Groot CJ, et al. Angiogenic and fibrinolytic factors in blood during the first half of pregnancy and adverse pregnancy outcomes. Obstet Gynecol. 2012;119(6):1190–200.PubMedCrossRef
18.
Tsiakkas A, Duvdevani N, Wright A, et al. Serum placental growth factor in the three trimesters of pregnancy: effects of maternal characteristics and medical history. Ultrasound Obstet Gynecol. 2015;45(5):591–8.PubMedCrossRef
19.
Gaillard R, Steegers EA, Tiemeier H, et al. Placental vascular dysfunction, fetal and childhood growth, and cardiovascular development: the generation R study. Circulation. 2013;128(20):2202–10.PubMedCrossRef
20.
Verburg BO, Steegers EA, De Ridder M, et al. New charts for ultrasound dating of pregnancy and assessment of fetal growth: longitudinal data from a population-based cohort study. Ultrasound Obstet Gynecol. 2008;31(4):388–96.PubMedCrossRef
21.
El Assaad MA, Topouchian JA, Darne BM, et al. Validation of the Omron HEM-907 device for blood pressure measurement. Blood Press Monit. 2002;7(4):237–41.PubMedCrossRef
22.
Coolman M, de Groot CJ, Jaddoe VW, et al. Medical record validation of maternally reported history of preeclampsia. J Clin Epidemiol. 2010;63(8):932–7.PubMedCrossRef
23.
Brown MA, Lindheimer MD, de Swiet M, et al. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy. 2001;20(1):IX–XIV.PubMedCrossRef
24.
Khawaja RA, Qureshi R, Mansure AH, et al. Validation of Datascope Accutorr plus using British hypertension society (BHS) and Association for the Advancement of medical instrumentation (AAMI) protocol guidelines. J Saudi Heart Assoc. 2010;22(1):1–5.PubMedPubMedCentralCrossRef
25.
Bergen NE, Schalekamp-Timmermans S, Roos-Hesselink J, et al. Hypertensive disorders of pregnancy and subsequent maternal cardiovascular health. Eur J Epidemiol. 2018;33(8):763–71.PubMedPubMedCentralCrossRef
26.
Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55(13):1318–27.PubMedCrossRef
27.
Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27(21):2588–605.PubMedCrossRef
28.
Benschop L, Schalekamp‐Timmermans S, Roeters van Lennep JE, Jaddoe VWV, Wong TY, Cheung CY, Steegers EA, Ikram MK. Gestational hypertensive disorders and retinal microvasculature: the Generation R Study. BMC Med. 2017;15:153.
29.
30.
Sterne JA, White IR, Carlin JB, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ. 2009;338:b2393.PubMedPubMedCentralCrossRef
31.
Strevens H, Wide-Swensson D, Ingemarsson I. Blood pressure during pregnancy in a Swedish population; impact of parity. Acta Obstet Gynecol Scand. 2001;80(9):824–9.PubMedCrossRef
32.
Gaillard R, Bakker R, Willemsen SP, et al. Blood pressure tracking during pregnancy and the risk of gestational hypertensive disorders: the generation R study. Eur Heart J. 2011;32(24):3088–97.PubMedCrossRef
33.
34.
Roberts JM, Taylor RN, Musci TJ, et al. Preeclampsia: an endothelial cell disorder. Am J Obstet Gynecol. 1989;161(5):1200–4.PubMedCrossRef
35.
Milne F, Redman C, Walker J, et al. The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community. BMJ. 2005;330(7491):576–80.PubMedPubMedCentralCrossRef
36.
Benschop L, Bergen NE, Schalekamp-Timmermans S, et al. Maternal lipid profile 6 years after a gestational hypertensive disorder. J Clin Lipidol. 2018;12(2):428–36 e4.PubMedCrossRef
Metadata
Title
Maternal cardiovascular adaptation to twin pregnancy: a population-based prospective cohort study
Authors
Maria C. Adank
Zoe A. Broere-Brown
Romy Gonçalves
M. Kamran Ikram
Vincent W. V. Jaddoe
Eric A. P. Steegers
Sarah Schalekamp-Timmermans
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Pre-Eclampsia
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-02994-w

Other articles of this Issue 1/2020

BMC Pregnancy and Childbirth 1/2020 Go to the issue

Research article

A qualitative study of the work experiences of midwives performing obstetric ultrasound in Norway

Case report

Late abdominal pregnancy in a post-conflict context: case of a mistaken acute abdomen - a case report

Research article

Influencing factors for prevention of postpartum hemorrhage and early detection of childbearing women at risk in Northern Province of Rwanda: beneficiary and health worker perspectives

Case report

Ovarian ependymoma presenting in pregnancy: a case report and literature review

Research article

Validity of self-reported and objectively measured sedentary behavior in pregnancy

Research article

Self-reported disrespect and abuse by nurses and midwives during childbirth in Tanzania: a cross-sectional study