Gestational hypertensive disease and birthweight discordance in twin pregnancies: a systematic review and meta-analysis

Introduction The objective of this systematic review was to explore the association between gestational hypertensive disease (GHD) and birthweight discordance in twin pregnancies. Methods PubMed, Embase, Web of Science and Cochrane Library were systematically searched for studies reporting the risk of birthweight discordance in twin pregnancies complicated compared with those not complicated by GHD from establishment until July 2021. Risk of bias was assessed with the Newcastle-Ottawa Scale. According to the classification of GHD, sub-group analyses reporting cases with gestational hypertension (GH), chronic hypertension (CH) and preeclampsia (PE) were performed separately. Stratification by twin chorionicity (dichorionic (DC) and monochorionic (MC)) was also conducted. When there was substantial heterogeneity (I-2 >= 50%), the random effect mode was used to estimate the pooled risk ratio, otherwise the fixed effect model was used. Results Nine studies (303,204 twin pregnancies) were included. GHD (OR 1.45, 95% CI 1.41-1.49) was a risk factor for intertwin birthweight discordance [PE (OR 1.69, 95% CI 1.33-2.16); CH (OR 1.59, 95% CI 1.46-1.73); GH (OR1.45, 95%Cl 1.10-1.92]. After stratification, birthweight discordance was related to GHD (OR 2.51, 95% CI 2.01-3.14), GH (OR 2.08, 95% CI 1.33-3.25) and PE (OR 2.74, 95% CI 2.09-3.61) in DC pregnancies, but no longer associated with GHD and PE in MC group. Conclusions Twin gestations complicated with GHD, especially in DC pregnancies, were at significantly higher risk of birthweight discordance.