Do maternal and neonatal outcomes differ with single or twin pregnancies affected by hypertensive disorders? A...

To compare maternal and neonatal outcomes of singleton and twin gestations complicated by hypertensive disorders of pregnancy (HDP).

PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Google Scholar were searched for comparative studies till 15th May 2025.

Thirteen studies were included. The analysis of crude data found a significantly elevated risk of preterm birth and cesarean section with twins compared to singleton gestations complicated by HDP. A significantly higher risk of small-for-gestational-age (SGA) was noted in twin pregnancies, but the effect was lost on subgroup analysis for preeclampsia. The analysis did not show any differences in 5-min Apgar score <7, respiratory distress, or neonatal intensive care unit (NICU) admission. Twin pregnancies were linked with significantly greater risk of neonatal death.

Twin pregnancies with HDP may be associated with significantly higher risk of preterm birth, cesarean section, SGA, and neonatal death, but without any difference in 5-min Apgar score <7, respiratory distress, and NICU admission as compared to singleton pregnancies complicated by HDP. Limited research indicates that twin pregnancies with preeclampsia may confer protection against SGA, but the findings should be interpreted with caution. Lack of adjustment of confounders is a major limitation of present evidence.