Risk factors and high-risk subgroups of severe acute maternal morbidity in twin pregnancy: A population-based study.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
04
10
2019
accepted:
10
02
2020
entrez:
29
2
2020
pubmed:
29
2
2020
medline:
12
5
2020
Statut:
epublish
Résumé
To determine risk factors of severe acute maternal morbidity in women with twin pregnancies and identify subgroups at high risk. In a prospective, population-based study of twin deliveries, the JUMODA cohort, all women with twin pregnancies at or after 22 weeks of gestation were recruited in 176 French hospitals. Severe acute maternal morbidity was a composite criterion. We determined its risk factors by multilevel multivariate Poisson regression modeling and identified high-risk subgroups by classification and regression tree (CART) analysis, in two steps: first considering only characteristics known at the beginning of pregnancy and then adding factors arising during its course. Among the 8,823 women with twin pregnancies, 542 (6.1%, 95% confidence interval (CI) 5.6-6.6) developed severe acute maternal morbidity. Risk factors for severe maternal morbidity identified at the beginning of pregnancy were maternal birth in sub-Saharan Africa (adjusted relative risk (aRR) 1.6, 95% CI 1.1-2.3), preexisting insulin-treated diabetes (aRR 2.2, 95% CI 1.1-4.4), nulliparity (aRR 1.6, 95% CI 1.3-2.0), IVF with autologous oocytes (aRR, 1.3, 95% CI, 1.0-1.6), and oocyte donation (aRR 2.0, 95% CI 1.4-2.8); CART analysis identified nulliparous women with oocyte donation as the subgroup at highest risk (SAMM rate: 14.7%, 95% CI, 10.3-19.1). At the end of pregnancy, additional risk factors identified were placenta praevia (aRR 3.5, 95% CI 2.3-5.3), non-severe preeclampsia (aRR 2.5, 95% CI 1.9-3.2), and macrosomia for either twin (aRR 1.7, 95% CI 1.3-2.1); CART analysis identified women with both oocyte donation and non-severe preeclampsia (SAMM rate: 28.9%, 95% CI, 19.9-37.9) and sub-Saharan nulliparous women with non-severe preeclampsia (SAMM rate: 26.9%, 95% CI, 9.9-43.9) as the two subgroups at highest risk. In woman with twin pregnancy, rates of severe acute maternal morbidity vary between subgroups from 4.6% to 14.7% and from 3.8% to 28.9% at the beginning and at the end of pregnancy respectively, depending on the combined presence of risk factors.
Identifiants
pubmed: 32109258
doi: 10.1371/journal.pone.0229612
pii: PONE-D-19-27799
pmc: PMC7048407
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0229612Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Am J Obstet Gynecol. 2016 Jan;214(1):122.e1-7
pubmed: 26283457
Obesity (Silver Spring). 2016 Jul;24(7):1590-8
pubmed: 27222008
BJOG. 2017 Nov;124(12):1858-1865
pubmed: 28342231
Am J Epidemiol. 2014 Aug 15;180(4):335-45
pubmed: 25028703
BJOG. 2008 Sep;115(10):1265-72
pubmed: 18715412
BMJ. 2001 May 5;322(7294):1089-93; discussion 1093-4
pubmed: 11337436
Am J Obstet Gynecol. 2015 Sep;213(3):384.e1-11
pubmed: 25957019
BJOG. 2008 Jun;115(7):842-50
pubmed: 18485162
Am J Obstet Gynecol. 2016 Aug;215(2):143-52
pubmed: 27179441
Am J Obstet Gynecol. 2018 Aug;219(2):185.e1-185.e10
pubmed: 29752934
Am J Obstet Gynecol. 2014 May;210(5):435.e1-8
pubmed: 24295922
Am J Obstet Gynecol. 2017 Sep;217(3):330.e1-330.e15
pubmed: 28455086
Natl Vital Stat Rep. 2018 Jan;67(1):1-55
pubmed: 29775434
Obstet Gynecol. 2017 Jun;129(6):986-995
pubmed: 28486364
Am J Obstet Gynecol. 2018 Oct;219(4):405.e1-405.e7
pubmed: 30012335
Am J Obstet Gynecol. 2016 May;214(5):641.e1-641.e10
pubmed: 26576487
Fertil Steril. 2017 Apr;107(4):948-953.e1
pubmed: 28283263
Eur J Public Health. 2015 Aug;25(4):620-5
pubmed: 25587005
Obstet Gynecol. 2019 Jun;133(6):1141-1150
pubmed: 31135727
J Gynecol Obstet Hum Reprod. 2017 Dec;46(10):701-713
pubmed: 29031048
Best Pract Res Clin Obstet Gynaecol. 2009 Jun;23(3):287-96
pubmed: 19303368
Fertil Steril. 2012 Jul;98(1):95-101
pubmed: 22608318
J Obstet Gynaecol Can. 2011 Aug;33(8):810-819
pubmed: 21846436
Am J Obstet Gynecol. 2006 Mar;194(3):888-94
pubmed: 16522430
Obstet Gynecol. 2016 Jan;127(1):59-66
pubmed: 26646124
CMAJ. 2019 Apr 1;191(13):E352-E360
pubmed: 30936165
Obstet Gynecol. 2014 Oct;124(4):771-81
pubmed: 25198279
J Clin Epidemiol. 2001 Jun;54(6):603-9
pubmed: 11377121