Hypertensive disorders of pregnancy after multifetal pregnancy reduction: a systematic review and meta-analysis

ABSTRACT

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.

KEYWORDS:

• Multifetal pregnancy
• multifetal pregnancy reduction
• hypertensive disorders of pregnancy
• meta-analysis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

PB, CG, and MB conceived and designed the study. PB and LS performed the literature search. PB, JW, and EH screened articles for inclusion. PB and MB extracted data and appraised the risk of bias of the identified articles. PB and MB analyzed the data. PB, JW, LM, EP, CG, and MB interpreted the results and revised and contributed to the intellectual content of the manuscript. All authors approved the final version of the manuscript.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10641955.2023.2225597

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.