Severe Acute Maternal Morbidity in Twin Compared With Singleton Pregnancies

Area of Science:

• Maternal-fetal medicine
• Obstetrics
• Public health

Background:

• Severe acute maternal morbidity (SAMM) poses a significant public health challenge.
• Twin pregnancies are often associated with increased obstetric risks.

Purpose of the Study:

• To investigate the association between twin pregnancy and severe acute maternal morbidity (SAMM).
• To analyze the timing and underlying causes of SAMM in twin pregnancies.
• To assess the role of cesarean delivery in mediating this association.

Main Methods:

• A cohort-nested case-control analysis was performed using data from the EPIMOMS prospective study (2012-2013).
• Cases included 2,500 women with SAMM (22 weeks gestation to 42 days postpartum).
• Controls comprised 3,650 women without SAMM; multilevel multivariable logistic regression and path analysis were used.

Main Results:

• The incidence of SAMM was 6.2% in twin pregnancies versus 1.3% in singleton pregnancies.
• Twin pregnancies had a significantly higher risk of SAMM (adjusted OR 4.2), occurring antepartum, intrapartum, or postpartum.
• Cesarean delivery mediated 20.6% of the intrapartum/postpartum SAMM risk in twin pregnancies.

Conclusions:

• Women with twin pregnancies have a fourfold increased risk of severe maternal complications compared to singleton pregnancies.
• This increased risk is observed both before and after delivery, across various causal conditions.
• Cesarean delivery plays a partial mediating role in the association between twin pregnancy and intrapartum/postpartum SAMM.