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

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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.

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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.