TY - JOUR
T1 - Hypertensive disorders of pregnancy after multifetal pregnancy reduction
T2 - a systematic review and meta-analysis
AU - van Baar, Petra M.
AU - Bij de Weg, Jeske M.
AU - ten Hove, Eibert A.
AU - Schoonmade, Linda J.
AU - van de Mheen, Lidewij
AU - Pajkrt, Eva
AU - de Groot, Christianne J. M.
AU - de Boer, Marjon A.
N1 - Funding Information: The author(s) reported that there is no funding associated with the work featured in this article. Publisher Copyright: © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2023
Y1 - 2023
N2 - Objective: To systematically review the literature on hypertensive disorders of pregnancy (HDP) after multifetal pregnancy reduction (MFPR). Methods: A comprehensive search in PubMed, Embase, Web of Science, and Scopus was performed. Prospective or retrospective studies reporting on MFPR from triplet or higher-order to twin compared to ongoing (i.e., non-reduced) triplets and/or twins were included. A meta-analysis of the primary outcome HDP was carried out using a random-effects model. Subgroup analyses of gestational hypertension (GH) and preeclampsia (PE) were performed. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. Results: Thirty studies with a total of 9,811 women were included. MFPR from triplet to twin was associated with a lower risk for HDP compared to ongoing triplets (OR 0.55, 95% CI, 0.37–0.83; p = 0.004). In a subgroup analysis, the decreased risk of HDP was driven by GH, and PE was no longer significant (OR 0.34, 95% CI, 0.17–0.70; p = 0.004 and OR 0.64, 95% CI, 0.38–1.09; p = 0.10, respectively). HDP was also significantly lower after MFPR from all higher-order (including triplets) to twin compared to ongoing triplets (OR 0.55, 95% CI, 0.38–0.79; p = 0.001). In a subgroup analysis, the decreased risk of HDP was driven by PE, and GH was no longer significant (OR 0.55, 95% CI 0.32–0.92; p = 0.02 and OR 0.55, 95% CI 0.28–1.06; p = 0.08, respectively). No significant differences in HDP were found in MFPR from triplet or higher-order to twin versus ongoing twins. Conclusions: MFPR in women with triplet and higher-order multifetal pregnancies decreases the risk of HDP. Twelve women should undergo MFPR to prevent one event of HDP. These data can be used in the decision-making process of MFPR, in which the individual risk factors of HDP can be taken into account.
AB - Objective: To systematically review the literature on hypertensive disorders of pregnancy (HDP) after multifetal pregnancy reduction (MFPR). Methods: A comprehensive search in PubMed, Embase, Web of Science, and Scopus was performed. Prospective or retrospective studies reporting on MFPR from triplet or higher-order to twin compared to ongoing (i.e., non-reduced) triplets and/or twins were included. A meta-analysis of the primary outcome HDP was carried out using a random-effects model. Subgroup analyses of gestational hypertension (GH) and preeclampsia (PE) were performed. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. Results: Thirty studies with a total of 9,811 women were included. MFPR from triplet to twin was associated with a lower risk for HDP compared to ongoing triplets (OR 0.55, 95% CI, 0.37–0.83; p = 0.004). In a subgroup analysis, the decreased risk of HDP was driven by GH, and PE was no longer significant (OR 0.34, 95% CI, 0.17–0.70; p = 0.004 and OR 0.64, 95% CI, 0.38–1.09; p = 0.10, respectively). HDP was also significantly lower after MFPR from all higher-order (including triplets) to twin compared to ongoing triplets (OR 0.55, 95% CI, 0.38–0.79; p = 0.001). In a subgroup analysis, the decreased risk of HDP was driven by PE, and GH was no longer significant (OR 0.55, 95% CI 0.32–0.92; p = 0.02 and OR 0.55, 95% CI 0.28–1.06; p = 0.08, respectively). No significant differences in HDP were found in MFPR from triplet or higher-order to twin versus ongoing twins. Conclusions: MFPR in women with triplet and higher-order multifetal pregnancies decreases the risk of HDP. Twelve women should undergo MFPR to prevent one event of HDP. These data can be used in the decision-making process of MFPR, in which the individual risk factors of HDP can be taken into account.
KW - Multifetal pregnancy
KW - hypertensive disorders of pregnancy
KW - meta-analysis
KW - multifetal pregnancy reduction
UR - http://www.scopus.com/inward/record.url?scp=85162640083&partnerID=8YFLogxK
U2 - https://doi.org/10.1080/10641955.2023.2225597
DO - https://doi.org/10.1080/10641955.2023.2225597
M3 - Review article
C2 - 37337887
SN - 1064-1955
VL - 42
JO - Hypertension in pregnancy
JF - Hypertension in pregnancy
IS - 1
M1 - 2225597
ER -