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Abstract：
OBJECTIVE: This study aimed to determine the association of first-trimester maternal serum biomarkers with preterm birth (PTB), fetal growth restriction (FGR) and hypertensive disorders of pregnancy (HDP) in twin pregnancies.
METHODS: This is a retrospective cohort study of twin pregnancies followed at Maternidade Dr. Alfredo da Costa, Lisbon, Portugal, between January 2010 and December 2022. We included women who completed first-trimester screening in our unit and had ongoing pregnancies with two live fetuses, and delivered after 24 weeks. Maternal characteristics, pregnancy-associated plasma protein-A (PAPP-A) and β-human chorionic gonadotropin (β-hCG) levels were analyzed for different outcomes: small for gestational age (SGA), gestational hypertension (GH), early and late-onset pre-eclampsia (PE), as well as the composite outcome of PTB associated with FGR and/or HDP. Univariable, multivariable logistic regression analyses and receiver-operating characteristic curve were used.
RESULTS: 466 twin pregnancies met the inclusion criteria. Overall, 185 (39.7%) pregnancies were affected by SGA < 5th percentile and/or HDP. PAPP-A demonstrated a linear association with gestational age at birth and mean birth weight. PAPP-A proved to be an independent risk factor for SGA and PTB (< 34 and < 36 weeks) related to FGR and/or HDP. None of the women with PAPP-A MoM > 90th percentile developed early-onset PE or PTB < 34 weeks.
CONCLUSIONS: A high serum PAPP-A (> 90th percentile) ruled out early-onset PE and PTB < 34 weeks. Unless other major risk factors for hypertensive disorders are present, these women should not be considered candidates for aspirin prophylaxis. Nevertheless, close monitoring of all TwP for adverse obstetric outcomes is still recommended.
METHODS: This is a retrospective cohort study of twin pregnancies followed at Maternidade Dr. Alfredo da Costa, Lisbon, Portugal, between January 2010 and December 2022. We included women who completed first-trimester screening in our unit and had ongoing pregnancies with two live fetuses, and delivered after 24 weeks. Maternal characteristics, pregnancy-associated plasma protein-A (PAPP-A) and β-human chorionic gonadotropin (β-hCG) levels were analyzed for different outcomes: small for gestational age (SGA), gestational hypertension (GH), early and late-onset pre-eclampsia (PE), as well as the composite outcome of PTB associated with FGR and/or HDP. Univariable, multivariable logistic regression analyses and receiver-operating characteristic curve were used.
RESULTS: 466 twin pregnancies met the inclusion criteria. Overall, 185 (39.7%) pregnancies were affected by SGA < 5th percentile and/or HDP. PAPP-A demonstrated a linear association with gestational age at birth and mean birth weight. PAPP-A proved to be an independent risk factor for SGA and PTB (< 34 and < 36 weeks) related to FGR and/or HDP. None of the women with PAPP-A MoM > 90th percentile developed early-onset PE or PTB < 34 weeks.
CONCLUSIONS: A high serum PAPP-A (> 90th percentile) ruled out early-onset PE and PTB < 34 weeks. Unless other major risk factors for hypertensive disorders are present, these women should not be considered candidates for aspirin prophylaxis. Nevertheless, close monitoring of all TwP for adverse obstetric outcomes is still recommended.
摘要：
目的：本研究旨在确定孕早期母体血清生物标志物与早产（PTB）的关系，双胎妊娠中胎儿生长受限（FGR）和妊娠高血压疾病（HDP）。
方法：这是一项对MaternidadeAlfredodaCosta博士进行的双胎妊娠的回顾性队列研究，里斯本,葡萄牙,2010年1月至2022年12月。我们纳入了在我们单位完成孕早期筛查并有两个活胎持续怀孕的妇女，并在24周后交付。产妇特征,分析妊娠相关血浆蛋白-A（PAPP-A）和β-人绒毛膜促性腺激素（β-hCG）水平的不同结局：小于胎龄（SGA），妊娠期高血压(GH),早发型和晚发型先兆子痫（PE），以及与FGR和/或HDP相关的PTB的复合结局。单变量,使用多变量逻辑回归分析和受试者工作特征曲线。
结果：466例双胎妊娠符合纳入标准。总的来说,185例(39.7%)妊娠受SGA<第5百分位数和/或HDP影响。PAPP-A与出生时的胎龄和平均出生体重呈线性关系。PAPP-A被证明是与FGR和/或HDP相关的SGA和PTB（<34周和<36周）的独立危险因素。PAPP-AMoM>90百分位数的女性均未发生早发性PE或PTB<34周。
结论：高血清PAPP-A（>第90百分位数）排除了早发性PE和PTB<34周。除非存在高血压疾病的其他主要危险因素，这些女性不应被视为阿司匹林预防的候选人.然而，仍建议密切监测所有TwP的产科不良结局.
方法：这是一项对MaternidadeAlfredodaCosta博士进行的双胎妊娠的回顾性队列研究，里斯本,葡萄牙,2010年1月至2022年12月。我们纳入了在我们单位完成孕早期筛查并有两个活胎持续怀孕的妇女，并在24周后交付。产妇特征,分析妊娠相关血浆蛋白-A（PAPP-A）和β-人绒毛膜促性腺激素（β-hCG）水平的不同结局：小于胎龄（SGA），妊娠期高血压(GH),早发型和晚发型先兆子痫（PE），以及与FGR和/或HDP相关的PTB的复合结局。单变量,使用多变量逻辑回归分析和受试者工作特征曲线。
结果：466例双胎妊娠符合纳入标准。总的来说,185例(39.7%)妊娠受SGA<第5百分位数和/或HDP影响。PAPP-A与出生时的胎龄和平均出生体重呈线性关系。PAPP-A被证明是与FGR和/或HDP相关的SGA和PTB（<34周和<36周）的独立危险因素。PAPP-AMoM>90百分位数的女性均未发生早发性PE或PTB<34周。
结论：高血清PAPP-A（>第90百分位数）排除了早发性PE和PTB<34周。除非存在高血压疾病的其他主要危险因素，这些女性不应被视为阿司匹林预防的候选人.然而，仍建议密切监测所有TwP的产科不良结局.
