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Maternal proteinuria in twin compared with singleton pregnancies.

Sarah S Osmundson1, Richard A Lafayette, Raffick A Bowen

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Twin pregnancies show higher 24-hour urinary protein excretion than singleton pregnancies. This suggests current diagnostic criteria for preeclampsia may need reevaluation in twin gestations.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Nephrology

Background:

  • Elevated urinary protein is a marker for hypertensive disorders in pregnancy.
  • Twin pregnancies have unique physiological adaptations compared to singleton pregnancies.

Purpose of the Study:

  • To compare 24-hour urinary protein excretion between twin and singleton pregnancies.
  • To assess if current diagnostic thresholds for proteinuria are appropriate for twin gestations.

Main Methods:

  • Prospective evaluation of 24-hour urinary protein excretion in twin and singleton pregnancies (24 0/7 to 36 0/7 weeks gestation).
  • Exclusion of participants with urinary tract infections, chronic hypertension, pregestational diabetes, or renal/autoimmune diseases.
  • Assessment of sample adequacy via urinary creatinine excretion adjusted for maternal weight.

Main Results:

  • Mean urinary protein excretion was significantly higher in twin pregnancies (269.3±124.1 mg) compared to singleton pregnancies (204.3±92.5 mg).
  • Proteinuria (≥300 mg/day) occurred in 38.0% of twin pregnancies versus 8.2% of singleton pregnancies.
  • After excluding women who later developed hypertensive disorders, the difference remained significant, with 43% of twins and 7% of singletons exhibiting proteinuria.

Conclusions:

  • Twin pregnancies exhibit greater mean 24-hour urinary protein excretion than singleton pregnancies.
  • The findings suggest a need to reevaluate diagnostic criteria for preeclampsia in the context of twin pregnancies.