Difference in adverse neonatal outcomes between preterm singletons and twins possibly explained by placental abnormalities

IF 3 2区医学 Q2 DEVELOPMENTAL BIOLOGY

Placenta Pub Date : 2025-02-19 DOI:10.1016/j.placenta.2025.02.010

Salma El Emrani , Jacqueline U.M. Termote , Esther J.S. Jansen , Jelle J. Goeman , Enrico Lopriore , Nicoline E. Schalij-Delfos , Lotte E. van der Meeren

{"title":"Difference in adverse neonatal outcomes between preterm singletons and twins possibly explained by placental abnormalities","authors":"Salma El Emrani , Jacqueline U.M. Termote , Esther J.S. Jansen , Jelle J. Goeman , Enrico Lopriore , Nicoline E. Schalij-Delfos , Lotte E. van der Meeren","doi":"10.1016/j.placenta.2025.02.010","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>The purpose of this study was to compare microscopic placental characteristics between preterm twins and singletons, and between preterm monochorionic and dichorionic twins, in order to explore the effect of placental pathology on adverse neonatal outcomes.</div></div><div><h3>Methods</h3><div>This study included 566 neonates born ≤32 weeks and/or ≤1500 g, of whom 429 were singletons and 137 were twins (38 monochorionic and 99 dichorionic). Clinical data was retrospectively collected, and placentas were prospectively examined for maternal vascular malperfusion, fetal vascular malperfusion and placental inflammation (acute and chronic).</div></div><div><h3>Results</h3><div>Singletons had increased rates of maternal vascular malperfusion, fetal hypoxia, funisitis (in umbilical cord and chorial plate), chronic deciduitis, and villitis of unknown etiology compared to twins. Delayed villous maturation and ischemia were more frequently present in monochorionic placentas than in dichorionic. Singletons had a significant lower birthweight and were more often small for gestational age than twins. Multivariate linear regression analysis adjusting for singleton pregnancy, gestational hypertension and placental abnormalities showed that gestational hypertension (β = −114.8), infarct (β = −130.1), decidual necrosis (β = −115.4), fetal hypoxia (β = −59.3) and chronic deciduitis (β = −118.8) were independently associated with lower birthweight. Multivariate regression analysis revealed five independent risk factors of small for gestational age: gestational hypertension (OR 4.4), infarct (OR 3.7), decidual necrosis (OR 2.7), fetal hypoxia (OR 1.9) and villitis (OR 5.2).</div></div><div><h3>Discussion</h3><div>Singleton pregnancies vary in histological placental abnormality rates from twin pregnancies. This study demonstrated that differences in birthweight and small for gestational age rates between preterm twins and singletons can be attributed to gestational hypertension and histological placental abnormalities.</div></div>","PeriodicalId":20203,"journal":{"name":"Placenta","volume":"162 ","pages":"Pages 45-50"},"PeriodicalIF":3.0000,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Placenta","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0143400425000438","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"DEVELOPMENTAL BIOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

The purpose of this study was to compare microscopic placental characteristics between preterm twins and singletons, and between preterm monochorionic and dichorionic twins, in order to explore the effect of placental pathology on adverse neonatal outcomes.

Methods

This study included 566 neonates born ≤32 weeks and/or ≤1500 g, of whom 429 were singletons and 137 were twins (38 monochorionic and 99 dichorionic). Clinical data was retrospectively collected, and placentas were prospectively examined for maternal vascular malperfusion, fetal vascular malperfusion and placental inflammation (acute and chronic).

Results

Singletons had increased rates of maternal vascular malperfusion, fetal hypoxia, funisitis (in umbilical cord and chorial plate), chronic deciduitis, and villitis of unknown etiology compared to twins. Delayed villous maturation and ischemia were more frequently present in monochorionic placentas than in dichorionic. Singletons had a significant lower birthweight and were more often small for gestational age than twins. Multivariate linear regression analysis adjusting for singleton pregnancy, gestational hypertension and placental abnormalities showed that gestational hypertension (β = −114.8), infarct (β = −130.1), decidual necrosis (β = −115.4), fetal hypoxia (β = −59.3) and chronic deciduitis (β = −118.8) were independently associated with lower birthweight. Multivariate regression analysis revealed five independent risk factors of small for gestational age: gestational hypertension (OR 4.4), infarct (OR 3.7), decidual necrosis (OR 2.7), fetal hypoxia (OR 1.9) and villitis (OR 5.2).

Discussion

Singleton pregnancies vary in histological placental abnormality rates from twin pregnancies. This study demonstrated that differences in birthweight and small for gestational age rates between preterm twins and singletons can be attributed to gestational hypertension and histological placental abnormalities.

查看原文本刊更多论文

单胎和双胞胎早产儿不良新生儿结局的差异可能与胎盘异常有关

本研究的目的是比较双胞胎和单胎、单绒毛膜双胞胎和双绒毛膜双胞胎的显微镜下胎盘特征，以探讨胎盘病理对新生儿不良结局的影响。方法本研究纳入566例≤32周和/或≤1500 g的新生儿，其中单胎429例，双胞胎137例（单绒毛膜38例，双绒毛膜99例）。回顾性收集临床资料，前瞻性检查胎盘是否存在母体血管灌注不良、胎儿血管灌注不良和胎盘炎症（急性和慢性）。结果与双胞胎相比，单胎的母体血管灌注不良、胎儿缺氧、子宫内膜炎（脐带和脉络膜板）、慢性蜕膜炎和不明原因绒毛炎的发生率明显增加。绒毛成熟延迟和缺血在单绒毛膜胎盘中比在双绒毛膜胎盘中更常见。单胞胎的出生体重明显低于双胞胎，而且比双胞胎的胎龄更小。调整单胎妊娠、妊娠高血压和胎盘异常的多因素线性回归分析显示，妊娠高血压（β = - 114.8）、梗死（β = - 130.1）、蜕膜坏死（β = - 115.4）、胎儿缺氧（β = - 59.3）和慢性蜕膜炎（β = - 118.8）与低出生体重独立相关。多因素回归分析显示胎龄小的5个独立危险因素：妊娠期高血压（OR 4.4）、梗死（OR 3.7）、蜕膜坏死（OR 2.7）、胎儿缺氧（OR 1.9）和绒毛炎（OR 5.2）。单胎妊娠与双胎妊娠的组织学胎盘异常率不同。本研究表明，早产双胞胎和单胎之间出生体重和胎龄小的差异可归因于妊娠期高血压和胎盘组织学异常。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Placenta 医学-发育生物学

CiteScore

6.30

自引率

10.50%

发文量

391

审稿时长

78 days

期刊介绍： Placenta publishes high-quality original articles and invited topical reviews on all aspects of human and animal placentation, and the interactions between the mother, the placenta and fetal development. Topics covered include evolution, development, genetics and epigenetics, stem cells, metabolism, transport, immunology, pathology, pharmacology, cell and molecular biology, and developmental programming. The Editors welcome studies on implantation and the endometrium, comparative placentation, the uterine and umbilical circulations, the relationship between fetal and placental development, clinical aspects of altered placental development or function, the placental membranes, the influence of paternal factors on placental development or function, and the assessment of biomarkers of placental disorders.