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Clinical Obstetrics

Poster Session 3

(712) Mode of delivery in preterm twin pregnancy and long-term cardiovascular morbidity of the offspring

Wednesday, February 14, 2024

8:30 AM – 10:00 AM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Dor Nissim, BSc

Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev
Beer Sheva, HaDarom, Israel

Coauthor(s)

Tamar Wainstock, PhD (she/her/hers)

Ben Gurion University
Beer-Sheva, HaDarom, Israel
Eyal Sheiner, MD, PhD

Head of department of Obstetrics and Gynecology B, Soroka University Medical Center
Soroka University Medical Center
Beer-Sheva, HaDarom, Israel
Gali Pariente, MD

Acting director of Fetal Maternal Unit B Division of Obstetrics and Gynecology
Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Klahim, HaDarom, Israel

Objective: Twin pregnancies are associated with higher rates of prematurity. The recommended mode of delivery in premature twin pregnancies is still under debate. Considering the known association between prematurity and long-term cardiovascular morbidity of the offspring, we opted to assess the association between mode of delivery of premature twins and long-term cardiovascular morbidity of the offspring.

Study Design: A population-based retrospective cohort study, assessing the association between mode of delivery in preterm twin pregnancy and long-term cardiovascular morbidity of the offspring was conducted. Twins were born between the years 1991-2021 in a single tertiary medical center. The study groups were followed until 18 years of age for cardiovascular-related morbidity. A Kaplan-Meier survival curve was used to compare cumulative cardiovascular morbidity between the groups, and a multivariable Cox proportional hazard analysis was used to adjust for confounders.

Results: During the study period 6,504 premature twins, born before 37 weeks gestation, were included, of which 3,868 (59.5%) were born through cesarean delivery (CD). Premature twins born through vaginal delivery did not demonstrate a significantly higher rate of long-term cardiovascular morbidity when compared with premature twins born through CD (2.9% vs. 2.8%, OR=0.96, 95% CI 0.71-1.30, p=0.82). Likewise, the cumulative incidence of long-term cardiovascular morbidity did not differ according to mode of delivery (Kaplan-Meier Log rank p=0.804, Figure). In a Cox proportional hazard model, the mode of delivery in premature twins was not associated with long-term cardiovascular morbidity of the offspring (adjusted HR=0.83, 95% CI 0.60-1.15, p=0.264).

Conclusion: In our population, no association was documented between mode of delivery in preterm twin pregnancies and long-term cardiovascular morbidity of the offspring. In the perspective of childhood cardiovascular morbidity, vaginal delivery in preterm twin pregnancies seems to be as safe as CD.