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Clinical Obstetrics

Poster Session 4

(1064) Risks of hospitalization for cardiovascular disease in the first year after delivery of twin pregnancies

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Ruby Lin, MD

    Maternal Fetal Medicine Fellow
    Rutgers Robert Wood Johnson Medical School
    New Brunswick, NJ, United States

    • Coauthor(s)

  • Jessica C. Fields, MD

    Fellow
    Christiana Health
    Jersey City, NJ, United States

  • RL

    Rachel Lee, MS

    Rutgers Robert Wood Johnson Medical School
    New Brunswick, NJ, United States

  • ER

    Emily B. Rosenfeld, DO (she/her/hers)

    Maternal Fetal Medicine Fellow
    Robert Wood Johnson Medical School, Rutgers University
    New Brunswick, NJ, United States

  • Emily E. Daggett, MD

    Obstetrics & Gynecology Resident Physician
    Rutgers Robert Wood Johnson Medical School
    CLEVELAND HTS, OH, United States

  • Ruchira Sharma, MD

    Assistant Professor
    Rutgers Robert Wood Johnson Medical School
    Manhasset, NY, United States

  • CA

    Cande V. Ananth, MPH, PhD

    Professor and Vice Chair for Academic Affairs, Department of Obstetrics, Gynecology, and Reproductive Sciences
    Rutgers Robert Wood Johnson Medical School
    New Brunswick, NJ, United States

Objective: Compared to singletons, patients carrying twins face increased risks of hypertensive disorders of pregnancy (HDP). We hypothesized that the increased plasma volume and cardiac output in twin pregnancies pose a greater risk of cardiovascular complications. We determined the risk of cardiovascular disease (CVD) related hospitalizations within the year following delivery in relation to HDP, comparing twin with singleton pregnancies.

Study Design:

We performed a retrospective cohort study of hospitalized singleton and twin births in the United States from 2010-2018, using the Healthcare Cost and Utilization Project Nationwide Readmissions Database. Using ICD coding, we identified all hospitalizations for CVD complications during the same calendar year after delivery in singleton versus twin pregnancies with and without HDP. We calculated rates of CVD readmission and expressed associations based on a confounder-adjusted hazard ratio (HR) with a 95% confidence interval (CI).

Results: Of a total of 30,606,363 delivery hospitalizations, 565,306 (1.8%) were twin births, of which 135,910 (24%) were affected by HDP. The rate of CVD readmission in twin and singleton pregnancies were 376.3 and 162.6 per 100,000 delivery admissions, respectively. Compared with singletons without HDP, the adjusted risk of CVD readmission was highest for twins with HDP (HR 5.12, 95% CI 4.43, 5.92), followed by singletons with HDP (HR 3.95, 95% CI 3.76-4.16) (Table). The increased risk of CVD readmission persisted among twins without HDP (HR 1.84, 95% CI 1.62, 2.09). The adjusted HRs for twins with HDP were substantially high for hypertensive heart disease (23.29, 95% CI 15.69, 34.57), heart failure (12.11, 95% CI 10.06, 14.58), and cardiomyopathy (9.47, 95% CI 6.72, 13.34).

Conclusion: Compared to singletons without HDP, twin pregnancies in general, and more so with HDP, are associated with increased risks for CVD complications in the first year postpartum. These findings underscore the increased strain twin pregnancies place on the maternal cardiovascular system and the need for short-term follow-up in this population.