Preeclampsia in twin pregnancies: time for differential approaches?

Twin pregnancies carry a 2-3 times higher risk of hypertensive disorders compared to singleton pregnancies. Despite this, clinical guidelines do not differentiate between the two.

Compare the onset, progression, and incidence of preeclampsia (PET) in twin versus singleton pregnancies, both antepartum and postpartum.

This retrospective single-center cohort study analyzed maternal and neonatal outcomes related to hypertension (HTN) in twin and singleton pregnancies from January 2008 to July 2021. Patients with pre-existing chronic HTN, kidney disease, or intrauterine fetal demise were excluded. Primary outcome was the gestational age at the diagnosis of severe PET. Secondary outcomes included rates of mild and severe HTN-related complications, gestational age and mean blood pressure at diagnosis, incidence of eclampsia, antihypertensive treatment requirements, and maternal and neonatal adverse outcomes.

A total of 403 twin and 3096 singleton pregnancies were included. Severe PET rates were significantly higher in twin pregnancies compared to singletons (34.0 % vs. 19.3 %, p < 0.001). Both mild and severe PET presented significantly earlier in twin pregnancies (35.7 ± 2.1 vs. 38.1 ± 2.6 weeks, p < 0.001; and 35.5 ± 2.3 vs. 37.5 ± 3.1 weeks, p < 0.001, respectively). Twin pregnancies also demonstrated increased antihypertensive treatment use and required multiple medications more frequently.

Preeclampsia in twin pregnancies develops earlier and presents more severely compared to singleton pregnancies. These findings highlight distinct clinical courses, underscoring the need for tailored management strategies. Enhanced monitoring and more aggressive interventions, including earlier delivery, may improve outcomes in twin pregnancies.